LALLEMAND 



SPERM ATORRHCEA 



PRACTICAL TREATISE 



CAUSES, SYMPTOMS, AND TREATMENT 



SPERMATORRHEA: 

BY 

M. LALLEMAND, 

FOBMERLY PROFESSOR OF CLINICAL SURGERY AT THE UNIVERSITY OF MONTPELLIER. 
.MEMBER OF THE ROYAL ACADEMY OF MEDICINE AT PARIS, ETC. ETC. 



£ranslatetr anti BUftetr to 
HENRY JrlcDOUGALL, 

MEMBER OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND ; FELLOW OF THE ROYAL 

MEDICAL AND CHIRURGICAL SOCIETY; AND FORMERLY HOUSE-SURGEON 

TO THE UNIVERSITY COLLEGE HOSPITAL. 



SECOND AMERICAN EDITION 




PHILADELPHIA: 

BLANCH A RD AND LEA*, 
1853. 






-^ 






y 7p 

,4> 



AUTHOR'S PREFACE. 



Duking a period of fourteen years, I have collected more than one 
hundred and fifty cases in which involuntary seminal discharges 
were sufficiently serious to disorder the health of the patients con- 
siderably, and even sometimes to cause death. 

Most of these patients have been sent to me on account of sus- 
pected cerebral affections of more or less standing. Hence, by a 
singular chance, it has been in consequence of the publication of my 
" Mecherches Anatomico-JPathologiques, sur Vencephale et ses depen- 
dences," that I have obtained the most remarkable cases of diurnal 
pollutions ; and I have correctly refused to acknowledge the presence 
of disease of the brain or its membranes in many cases where the 
existence of such disease had previously been considered indis- 
putable. 

Many other of these patients were supposed to suffer from chronic 
gastritis, or gastro-enteritis ; from aneurisms near the heart, the 
early symptoms of phthisis, &c, &c. ; and in other cases from ner- 
vous affections, and especially from hypochondriasis. 

These few words show how frequent, important, and difficult of 
detection, are involuntary seminal discharges, and to what deplorable 
errors of treatment they daily give rise : it may be foreseen, too, that 
their causes must be very varied, and their treatment present con- 
siderable difficulties. 

The Brochure of Wickman and the commentaries on it by Sainte- 
Maria, 1 are the only writings we possess, on a disease that degrades 
man, poisons the happiness of his best days, and ravages society ! 
Of the researches of these conscientious observers, too, the profession 
are almost ignorant. 

Theyliave, nevertheless, done all in their power to call the atten- 



' Dissertation sur la pollution diurne involontaire ; par Wickmann; traduction de 
-Maria. — Lyons, 1817. 



VI PREFACE. 

tion of practitioners to a subject of which they fully felt the impor- 
tance, and they have stated many valuable truths. Why is it, then, 
that a more lasting impression has not been made on the medical 
world ? Doubtless because they have not supported their statements 
by a sufficient number of well detailed cases, and especially because 
those related are vaguely and generally stated. 

Although Wickmann and Sainte-Maria have stated facts which 
have not been appreciated, they have left numerous omissions to be 
supplied, and more than one serious error to be corrected. . 

The materials I possess permit me to hope that I shall be more 
successful: at all events. I consider it my duty to publish them. 



Vll 



EDITOR'S PREFACE. 



In laying the following condensed edition of M. Lallemand's im- 
portant work on Involuntary Seminal Discharges before my profes- 
sional brethren in an English dress, I have been actuated by the con- 
viction that the disorder treated of is little understood by the profes- 
sion generally in this country. The patients affected by it are always 
hypochondriacal — indeed, the symptoms of hypochondriasis and men- 
tal derangement are generally by far the most prominently marked in 
them— and after the usual remedies for digestive disorder and liver 
disease have been had recourse to without benefit, the practitioner 
becomes tired of attending a disease which is at best obscure and 
does not yield to the usual remedies, and either treats his patient as 
a malade imaginaire, or leaves him a prey to the wretched balsam- 
selling quacks, who are unfortunately permitted to pollute every pe- 
riodical publication with their disgusting advertisements. 

The subject of Spermatorrhoea is an uninviting one — 'especially to 
the fastidious — perhaps too fastidious English taste ; — hence, with 
very few exceptions, it has been generally avoided by regularly edu- 
cated practitioners in this country. An abstract of M. Lallemand's 
views was indeed published by my friend Mr. Phillips, in the Medi- 
cal Gazette in the year 1843, and about the same time some papers 
appeared in the Lancet on the same subject by Drs. Ranking and 
Dangerfield, and Messrs. Ryan, Chatto, and Dudgeon. These pub- 
lications, however, from their transitory nature, were not calculated 
to remedy the want felt by the profession, of a systematic treatise on 
this important subject. Mr. Phillips indeed, in the conclusion of his 
paper in the Medical Gazette, takes occasion to remark: "Since the 
publication of the first part of this paper, I have been painfully im- 
pressed with the conviction, that the evil is more widely spread than 
I had before conceived; and that it will not be largely alleviated by 
the means I have adopted for advocating the relief of a particular 

remedy The pages of a strictly Medical Journal do not meet 

the eyes of the great mass of sufferers." 

In a notice also of M. Lallemand's work, in the British and Foreign 
Medical Review, the reviewer took an opportunity of pointing out the 
importance of the subject. Nevertheless, authors have always seemed 
to avoid the subject as dangerous ground, and with the exception of 



Vlll PREEACE. 

an excellent chapter in Mr. Curling's work on Diseases of the Testis, 
and some observations published by Dr. Smyth, in a work entitled 
"'Miscellaneous Contributions to Pathology and Therapeutics," I 
believe the present to be the first attempt to render the profession 
familiar with this disorder, by any special work in the English lan- 
guage. 

Indeed, in Dr. Golding Bird's otherwise excellent book on urinary 
deposits, the author, although he admits that the spermatozoa are fre- 
quently discovered in the urine by microscopic examination, takes 
occasion to express his opinion, that the subject of spermatorrhoea is 
one by no means deserving the importance attached to it. He adds, 
" It certainly is not very consistent with our national character, to 
dilate so freely on a subject which, in the great majority of cases, can 
be treated of only as the effects of a most degrading vice." That 
any physician should relieve himself from the investigation of a most 
afflicting disease, because the subject treated of is an unpleasant one, 
appears to me unworthy the general character of our profession. Had 
similar opinions been held respecting syphilis — a subject quite as re- 
pugnant to English feelings as spermatorrhoea, — what misery would 
have been entailed on the human race ! 

Lecturers on surgery, while entering fully on other diseases of the 
urethra, appear either not to have been aware of, or by common con- 
sent to have omitted, spermatorrhoea from their oral lectures and text- 
books of surgery. Professor Miller of Edinburgh having given a 
short notice of spermatorrhoea in his "Practical Surgery," published 
in 1846, is, as far as I am aware, the only exception to this rule. 

At an early part of my professional life my attention was much en- 
gaged by two cases, which to me presented peculiar features of interest. 
One, the case of a near relative, since dead, proved particularly unfor- 
tunate. The other, the case of a friend of about my own age — also 
studying medicine, — recovered after several relapses; and the pa- 
tient is at present practising his profession in her Majesty's service. 
In both cases the best advice the West of England afforded was ob- 
tained without success, or indeed, even slight improvement, and in 
neither case was the cause of the disorder, which particularly affected 
the brain and digestive organs, recognised. 

The interest I took in these cases led me to suspect, from certain 
hints thrown out by the patients, that their disorders were somehow 
connected with the genital organs. Further experience has con- 
vinced me that my suspicions were correct. 

A brief outline of these cases may not be uninteresting. 

K. H — , set. thirty-nine, passed the early part of his life in the 

country, and was in the habit of taking much and violent exercise. 
About the age of sixteen, he entered a banking establishment in Lon- 
don, in which by great diligence and steadiness of conduct he rose, 
before he was twenty-five, to the post of cashier. The affairs of the 
house fell into disorder, and ultimately a bankruptcy occurred ; Mr. 
H , from the amount of confidence reposed in him by the 



PREFACE. IX 

partners of the firm, was much harassed during these unfortunate pro- 
ceedings. Soon afterwards he became manager of a large mercan- 
tile establishment in the city, and about this time commenced some 
speculations in foreign bonds. From fluctuations in the share market 
he was a loser to a considerable extent ; his mind was much harassed, 
and he began to suspect those about him of dishonesty towards their 
employers. On investigation these suspicions were proved to be 
totally unfounded ; Mr. H * gave way to great violence of con- 
duct, and resigned his situation. About this time his father died; 

and Mr. H was much disappointed at finding that property, 

which he had incorrectly believed entailed, and consequently his, as 
eldest son, was left by will to be equally divided between himself and 
the rest of his family. His conduct at this period was of the strangest 
description. He dreaded to go out into the streets of the town where 
his family resided, refused to join in their meals, and ultimately ab- 
ruptly left their house to return to London. In 1837 his state had be- 
come such that in consequence of his repeated letters, members of his 
family visited London, and on their return took him with them into 
Devonshire. About this time his mental disorder put on a decided 
aspect; and I had then, as well as later, ample opportunities of ob- 
serving his conduct; and frequently heard his complaints. Emissa- 
ries were constantly on the search for him to arrest him for unnatural 
crimes committed in London; every one who met him in the street 
read in his countenance the crimes he had committed ; tailors made 
his coats with his sleeves the wrong way of the cloth, in order to 
brand him with infamy; the sight of a policeman in the street alarmed 
him beyond measure ; and often, if a stranger happened to be walking 
for some little time in the same direction as himself, he would ex- 
claim that he was one of the emissaries sent to seize him. At other 
times he would lock himself in his room and weep by the hour. He 
never took his meals with the family, and never tasted food or drink 
without first preserving a portion for chemical analysis, as he was con- 
vinced his friends were in a conspiracy to poison him slowly, in order 
to wipe out the memory of his crimes. These ideas haunted him 
night and day. His digestion was much disordered; his sleep broken 
and restless, and his bowels excessively constipated. His face was 
flushed, and periodical attacks of cerebral excitement occurred, during 
which he complained of vertigo, noise in the head, loss of sight, &c. 
He complained also of loss of memory, and frequently of bodily weak- 
ness and lassitude. The best medical advice the neighbourhood 
afforded was obtained, unavailingly ; the opinions of the gentlemen 

consulted were, that Mr. H was labourina; under a^ravated 

hypochondriasis, complicated with monomania. Various causes were 
suggested as giving rise to the disorder, but no previous case of in- 
sanity was recollected in any branch of the family. Mr. H 

now began to talk of leaving England for America, in order to avoid 
his persecutors ; and to prevent this he was placed under the care of 
a private keeper : while with this person he frequently and bitterly com- 



X PREFACE. 

plained of constant pollutions while at stool, with darting pain, and 
a sense of weight between the rectum and bladder. He had also 
urethral irritation attended with discharge, pains in his loins, and in 
one groin, weakness of his legs, thick urine, piles, and obstinate cos- 
tiveness. He kept a diary at this time, which is at present in my 
hands. Not a day is passed in this diary without mention of the dis- 
tressing seminal discharges from which he suffered. These were 
treated as of no importance by his medical attendants, although he 
never ceased to complain of them, and solicited aid so long as he con- 
tinued in confinement in England. When led away from his dis- 
order into any discussion on public matters, he was, however, a most 
amusing and instructive companion ; as a man of business he was 
equally acute, and to a stranger, as long as nothing was done to offend 
him, he was, to all appearance, a man of observation and experience 
in life. For about two years and a half he was under the care of 
various gentlemen, devoted to the insane, and at length he was dis- 
charged from an establishment near Bath, by the visiting magistrates, 
as a person confined without due cause. His first act was to com- 
mence legal proceedings against his friends for his detention, and 
having gained his action, he immediately proceeded to London, and 
waylaid and violently assaulted a gentleman of high commercial 
standing in the city. After this offence he was confined for a con- 
siderable period in default of bail, and immediately on his liberation 
it is believed that he proceeded to America. From this time nothing 
was heard of him until September, 1843, when a letter was received 
T)y a gentleman who formerly attended him, in which he stated that 
the same course of persecution was pursued towards him in America 
as had been followed in England. He complained of not being able 
to obtain efficient medical treatment, although he had applied to the 
most eminent practitioners in Cincinnati, and afterwards at Philadel- 
phia and New York. After this, nothing more was heard of Mr. 
H until the year 1845, when an American newspaper was for- 
warded to his friends by an unknown hand, containing an account 
of his death, and of an inquest held on him, headed, "Death of a 
Hermit in West Jersey." It was stated that he lived on a small 
farm, entirely alone, with the exception of a dog, and that he had 
shunned all intercourse with his neighbours. He was taken suddenly 
ill, applied to a neighbouring farmer for assistance, but died in the 
course of the following day. From information subsequently ob- 
tained by his friends, it is believed that he died of apoplexy, or per- 
haps, in one of the attacks of congestion of the brain, from which 
he frequently suffered before he left his native country. 

The symptoms of this unfortunate case strongly resemble those of 
the thirty-second and fifty-sixth cases related by M. Lallemand. It 
was more aggravated, however, and presented the somewhat uncommon 
feature of the patient's discovering the frequent pollutions, and con- 
stantly complaining of them : these, unfortunately, were treated as 
matters of no importance. Mr. H 's insanity, at first, constantly 



PREFACE. XI 

had reference to his having either committed or been accused of com- 
mittingunnatural crimes, and this idea never entirely left him, although 
during the latter part of his life, his more prominent hallucinations 
had reference to imaginary persecutors constantly watching him, and 
endeavouring to ruin him by spreading false reports, and to poison 
him by adulterating his food, and infusing noxious gases into the air. 
There can be little doubt, on taking into consideration his complaints 
of weight between the rectum and bladder, with darting pains, &c, 
in the same region, that the pollutions arose from irritation in the 
neighbourhood of the prostate, and I think, that if at an early period 
of his disease this had been relieved, there would have been con- 
siderable hope of his recovery from the hallucinations he manifested. 
The other case to which I have alluded as particularly attracting 
my attention, and which came under my notice about the same time, 
was that of a young man of high intellectual power and general talents, 
studying medicine. This gentleman was one of my most constant- 
companions, when almost suddenly a serious change came over him 
— he shunned society, especially that of females, was morose, taciturn, 
and frequently shed tears; he sat sometimes for hours in a kind of 
abstraction, and on being aroused from it, he could give no explana- 
tion of his thoughts and feelings ; he constantly expressed to me his 
conviction that he should never succeed in his profession, and fre- 
quently exclaimed that he was ruined both here and hereafter — body 
and soul — and by his own folly. About twelve months previous to 
this depression of spirits, he had a very severe attack of blennorrhagia, 
with orchitis and phimosis. This left a degree of irritability in the 
bladder, which required him to pass urine frequently. His digestion 
became so disordered that the simplest food would not remain on his 
stomach, and he had frequent eructations of fluid, which blazed like 
oil if spit out into the fire. This gentleman's father was a physician, 
and being naturally anxious for his son, obtained for him the advice 
of many of the most eminent of the faculty. No improvement took 
place, however. After he had been six months in this state, I had an 
opportunity of spending three weeks by the sea side, and my friend 
accompanied me. We slept in the same room, and he was scarcely 
ever out of my sight. Before our return, his health was almost re- 
established, and his spirits had returned to their natural condition. 
Twelve months later, however, he again fell into the same state of 
despondency, and this time his condition was much worse than on 
the. former occasion. He frequently remained in bed three parts of 
the day, and no threats or entreaties on the part of his father could 
induce him to get up. His intellectual faculties were totally pros- 
trated, and a vacant stare which took the place of his natural lively 
expression, induced considerable fears of his ultimately becoming 
idiotic. I was the only person who possessed any influence over 
him, which may perhaps be attributed to his feeling that I was aware 
of the cause of his disorder. This state continued between three and 
four months, during which time I was with him as much as my other 



XII PREFACE. 

duties would permit, and frequently showed him the folly of the 
course he pursued. At the expiration of this time he gradually re- 
covered. He has since had a slight relapse once only ; he has pur- 
sued his professional studies with success, and is at present a medical 
officer in her Majesty's service. 

On this case, I need only remark, that the symptoms did not 
arise from involuntary seminal discharges, but from excessive dis- 
charges caused by abuse. The various treatment recommended by 
the distinguished practitioners consulted, proved unsuccessful, be- 
cause the origin of the disorder was unrecognised, and the remedies 
consequently useless, while the habits of abuse were continued. 

Such were the two cases which first attracted my attention to the 
influence of the generative organs over the system generally, and the 
brain especially; and my suspicions once awakened, further observa- 
tions soon convinced me of their correctness, as well as of the frequent 
occurrence of such cases. I was soon convinced too, that the pro- 
fession generally, either were not aware of the immense importance 
of these discharges, or, that by a kind of common consent they neg- 
lected to recognise a subject certainly repugnant to delicacy. As a 
consequence, sufferers finding themselves neglected by their ordinary 
medical attendants, rush to find relief wherever there seems to them 
the slightest chance of its being obtained; and the ignorant and ra- 
pacious advertising quacks have a rapid and profitable sale for their 
injurious nostrums. Several cases of gross imposition by these char- 
latans have come under my notice, which it is my intention, at some 
future period, to lay before the profession in one of our medical 
periodicals. Their introduction here would swell these prefatory 
observations to an inconvenient length. 

It now remains for me to make a few remarks on one or two points 
of my own experience respecting the symptoms and treatment of 
spermatorrhoea. One symptom which I have three times met with as 
the result of masturbation, is little more than alluded to by M. Lalle- 
niand — I mean epilepsy. Masturbation is admitted by most medical 
men to be a frequent cause of epilepsy; and I am surprised to find 
that M. Lallemand has related no cases in which epilepsy occurred. 
Two of the three cases to which I have alluded were simple uncom- 
plicated cases of epilepsy brought on by masturbation. In these, 
after the masturbation had been arrested the effect ceased. The third 
case, however, was by no means so successful; it occurred in a lad 
of weak intellect, aged sixteen. The attacks of epilepsy frequently 
took place as often as twice in the day. He admitted that he was in 
the constant habit of practising masturbation, and even seemed aware 
of the influence the practice had in producing his fits. I have reason 
to believe that this lad corrected himself; but from the weakness of 
his intellect, much dependence could not be placed on his statements. 
As long as he continued to attend the dispensary at which I saw him, 
little improvement took place in his general health, and the epileptic 
paroxysms continued very frequent. I regret that I took no notes of 



PREFACE. Xlll 

this case, and still more, that I lost sight of the patient, as I am in- 
clined to believe that the epileptic paroxysms might have been kept 
up by involuntary seminal discharges, after having been once ex- 
cited by masturbation. This is a point which I earnestly recommend 
to the attention of the profession. 

Another very frequent symptom in cases of spermatorrhoea, is the 
occurrence of urethral discharge from very slight excitement. Several 
cases of this kind have come under my notice, the patients having 
consulted me on account of the discharge. These cases often give 
rise to distressing suspicions, and much family unhappiness, espe- 
cially as they often occur in married men. The symptoms are often 
almost as severe as those of virulent clap, and the discharge is at- 
tended with great irritation in the neighbourhood of the prostate, and 
frequent desire of micturition. The discharge came on in one case 
of a married man who consulted me, after taking a single tumbler of 
whiskey and water at night — this gentleman not having been in the 
habit of taking spirits for several years, on account of continued ill 
health. The discharge in these cases is thicker than that of ordinary 
clap, and sticks in patches on the linen. These patches may be 
scaled off. after which there is little mark left, and the discharge 
seldom penetrates through calico, so that on the opposite side of the 
shirt there is little or no appearance of stain. On wetting the linen, 
the discharge feels slippery, and it is washed off with difficulty. I 
am inclined to believe that these discharges are not contagious; but 
notwithstanding this, sexual intercourse should be avoided on account 
of the injury that may result to the patient himself. In most cases 
indeed, connexion is impossible during the first stages of the dis- 
charge, on account of the painful chordee to which excitement gives 
rise. 

I have generally, on questioning these patients, found that such 
discharges were connected more or less with deficiency of generative 
power. In the case I have above alluded to, impotence was almost 
complete ; and in another similar case occurring in the person of a 
married surgeon, the powers had greatly declined. Both these pa- 
tients were in the prime of life, and both had, in their youth, led very 
irregular lives. 

The irritation in these cases, I am inclined to believe, is situated in 
the posterior part of the urethra. Indeed, the surgeon whose case I 
have just alluded to, believed himself affected by enlarged prostate — 
many of the symptoms of which generally accompany the discharge I 
have described, especially frequent desire to pass water, and a feeling 
as though the bladder were never completely emptied, or as though 
two or three drops of urine were retained in the posterior part of the 
urethra. 

In the treatment of these cases, I have found the application of the 
solid nitrate of silver most effectual. The condition of the mucous 
membrane is immediately modified by it; within twelve hours the 



XIV PREFACE. 

patient experiences a degree of comfort to which, very frequently, he 
had long been a stranger. The condition of the membrane, too, seems 
permanently altered by this treatment; and the discharge has never, 
as far as my experience goes, returned after subsequent excitement — 
a circumstance which is very apt to occur when the discharge has 
been arrested by other means. The involuntary seminal discharges 
often present in these cases, and to which the diminution of virile 
power is generally due, are also at the same time arrested, and the 
patient experiences a return of vigour wholly unexpected. 

This peculiar form of urethral discharge has hitherto, for the most 
part, I believe, been confounded with contagious clap ; indeed, many 
members of our profession are in the habit of setting down all dis- 
charges from the urethra indiscriminately as the result of impure con- 
nexion, however positive the patient may be that such has not taken 
place. In all the cases I have hitherto met with, however, the pa- 
tients have admitted that they had previously been affected with con- 
tagious clap — frequently on more than one occasion. The discharges 
I have described are, I am inclined to believe, from the number of 
cases I have met with since my attention was first attracted by the 
subject, by no means uncommon, and certainly deserving the careful 
attention of the profession. 

The diagnosis of spermatorrhoea, in aggravated or long-standing 
cases, is by no means easy. When frequent diurnal pollutions have 
deteriorated the patient's health — discharge of watery semen taking 
place almost every time the patient makes water — the spermatozoa 
are often only distinguishable under the microscope after a long-con- 
tinued and patient manipulation ; and perhaps for no researches con- 
nected with medical science is it more important to possess one of the 
best microscopes. When I first commenced the study of this subject, 
I was more than once tempted to give it up in despair, in consequence 
of my not possessing a perfect microscope. At present I use one of 
Powell's instruments, which I prefer to those constructed by Eoss, on 
account of the greater convenience of the motions of the stage — a 
matter which will be found of much importance in all researches re- 
quiring delicate manipulation. The eighth of an inch object glass 
will be found almost indispensable in the study of these cases, al- 
though the spermatozoa in healthy semen can be perfectly well ex- 
amined with an object glass of a quarter of an inch focal length. 

M. Lallemand has described the operation of cauterization as a 
very painful one, and its after effects as very severe. This by no 
means accords with my experience. In no case in which I have 
performed the operation has the pain been severe, or the subsequent 
inflammation violent ; indeed, I have several times had difficulty in 
persuading the patients to remain twenty-four hours in bed after the 
operation — a precaution which I have thought advisable in all cases. 
At first I feared that sufficient inflammation had not been excited, and 
that the operation would require to be repeated — this has only hap- 



PREFACE. XV 

pened in my practice once, however, and in that case I am inclined 
to think that the caustic was not properly applied to the surface of 
the prostate on the first occasion. 

The instrument commonly sold for the purpose of cauterizing the 
prostate, by instrument makers in this country is, in my opinion, ex- 
ceedingly defective. From its being made nearly straight, it is by 
no means easily introduced when the patient is lying down — and in 
no other position ought the operation to be attempted — the irrita- 
bility of the canal, too, increases the difficulty of introduction, and 
consequently, every possible facility should be given to the operator, 
by having the instrument constructed of a convenient form. It is 
difficult, also, to measure the length of the passage exactly by applying 
a curved catheter to a nearly straight porte-caustique. I have, there- 
fore, had an instrument constructed of precisely the same curve as 
the catheters I generally use. This instrument is rather larger than 
those generally sold, being about the size of a No. 6 catheter, and 
its bulbous extremity is two sizes larger, or as large as a No. 8 cathe- 
ter ; with this instrument many of the difficulties of cauterization 
are avoided. It can be easily introduced like an ordinary catheter 
while the patient is lying on his back ; the moment when the bulb 
enters the neck of the bladder is clearly distinguishable by the sen- 
sation communicated ; and the caustic, on account of the greater size 
of the curvette, is more fairly applied to the whole of the inferior 
surface of the urethra, which is to a certain extent distended by its 
presence. With regard to the other precautions to be used, I quite 
agree with M. Lallemand. 

In translating the following pages I have endeavoured more to 
render the sense of the author in as few words as possible, than to 
give a full and literal translation. I must beg my readers to bear 
in mind that M. Lallemand's treatise consists of three thick octavo 
volumes — these having been written at different periods, there are 
of course many repetitions, which I have as much as possible en- 
deavoured to avoid. The total number of cases related by M. Lalle- 
mand is one hundred and fifteen. Of these I have selected sixty- 
two, which, after mature consideration, appear to me to illustrate the 
subject sufficiently. The same reason which induced me to omit so 
many of M. Lallemand's cases, has prevented me from inserting 
cases from my own experience. As I have endeavoured to render 
this entirely a practical work — I have omitted M. Lallemand's in- 
teresting researches on the spermatozoa, except as far as they refer 
to the diagnosis of spermatorrhoea as well as several digressions made 
by M. L. to topics of no practical interest in this country ; of these 
a disquisition on the character of J. J. Rousseau is one of the most 
remarkable. 

In speaking of spermatorrhoea arising from contagious urethritis, 
I have avoided the word gonorrhoea as being a misnomer, substi- 
tuting for it blennorrliagia, which is certainly more correct in its 
derivation, although also liable to some objections. 



XVI PEE FACE. 

In conclusion, I must beg to express my thanks to M. Lallemand 
for the kind and complimentary manner in which he was pleased to 
grant me permissson to undertake my task, as well as for the aid he 
has more than once afforded me in performing it. If through the 
medium of the following pages the profession becomes more fully 
acquainted with, and consequently better able to relieve, one of the 
most distressing disorders that affect mankind, I shall feel perfectly 
satisfied in the conviction that the time I have appropriated to the 
subject has not been entirely misspent, 

29, Berners Street, 



CONTENTS 



Page, 

Author's Preface . xiii 

Editor's Preface . . . . • . xv 



CHAPTER L 

Introduction 



CHAPTER II. 

INFLAMMATION OE THE SPERMATIC ORGANS, 

Pathological Anatomy . . . . .36 

Case I. — Biennorrhagia — Diurnal Pollutions — -Hypochondriasis— Chronic 
affection of the Brain and its Membranes — Death. Autopsy— 
Right Kidney in a state of Suppuration — Prostate nearly destroyed. 
Ejaculatory Ducts ulcerated — Seminal Vesicles altered— Nothing 
remarkable in the other organs . . . . .3? 

Case II. — Biennorrhagia — Spermatorrhoea— Hypochondriasis — Frequent 
attacks of Cerebral Congestion — Death. Autopsy — Suppuration 
in the Seminal Vesicles — Ossific deposit in the Vasa Deferentia — ■ 
Cystitis — Phlebitis — Old adhesions of the Arachnoid and Pleurae — 
Abscesses in the muscles of the Neck and Shoulders. 

Case III. — Biennorrhagia — Retention of Urine, &c. — Apoplexy — Death 
Autopsy — Effusion of Blood into the left Ventricle of the Brain — 
Hypertrophy of the Heart — Gastro-enteritis — Abscess and Tuber 
cles in the Kidney and Prostate — Stricture, &c. 

Case IV. — Mental Derangement — Belief in a change of Sex — Death- 
Autopsy — Thickening of the Arachnoid — Great alteration of the 
Prostate — Atrophy and obliteration of the ejaculatory Ducts 

Summary of the preceding Observations. — Symptoms 
Lesions in the Prostate .... 



In the Spermatic Organs 

In the Orifices of the Ejaculatory Ducts 

2 



4: 



46 



49 

51 
58 
54 



XV111 



CONTENTS. 



In the Ej a dilatory Ducts 

In the Seminal Vesicles 

In the Qualities of the Semen 

In the Yasa Deferentia 

In the Testicles 

In the Urinary Organs 
Comparison of the two Sets of Organs 
Resume .... 



54 

55 
55 
55 
57 
51 
58 
61 



CHAPTER III. 

CAUSES OF SPERMATORRHEA. 

Blennorrhagia . . . . . .62 

Case V. — Lymphatic Temperament — Blennorrhagia — Orchitis — Nephri- 
tis — Nocturnal and Diurnal Pollutions — Abuse of Mercurials- 
Injurious effects of Cold and Tonics — Cure by means of Leeches, 
the use of Flannel and Milk Diet — Fresh attack of Blennorrhagia 
— Same Treatment with the same Result . . . .62 

Case VI. — Masturbation — Blennorrhagia — Diurnal Pollutions — Failure 
of the ordinary modes of Treatment — Cauterization of the Prosta- 
tic Portion of the Urethra — Rapid Recovery . . .66 

Case VII. — Abuse of Spirituous Liquors — Blennorrhagia — Nocturnal 
Pollutions — Impotency — Frequent discharge of Urine — Cauteriza- 
tion — Cure . . . . . . 69 

Case VIII. — Masturbation — Blennorrhagia, repeated anti- venereal Treat- 
ment — Diurnal Pollutions — Increasing Weakness, especially of 
the Mental Faculties — Extreme Emaciation — Cauterization, and 
Cure after Sixteen Years — Venereal Excess, Relapse — Cauteriza- 
tion again performed with success , . . .71 

Case IX. — Blennorrhagia, followed by Excoriations of the Glans Penis 
— -Spermatorrhoea — Cauterization unsuccessful — Artificial Sulphur 
Baths— Cure . . . . . .74 

Consideration of the Causes . . . .75 

Mode of Action . . . . . .77 

Treatment of Spermatorrhoea following Blennorrhagia . 79 

Symptoms of Spermatorrhoea arising from Blennorrhagia . 80 



CHAPTER IV. 

CAUSES OF SPERMATORRHOEA CONTINUED. 

Cutaneous Affections . 

Case X. — Itch during Ten Months, at about the age of Fourteen — Pain 
in the Epigastrium — Tumour of the Testicle — Chronic Inflam- 
mation of the Bladder — Diurnal Spermatic Discharges — Hypo- 
chondriasis. Cure by Cauterization at the age of Twenty-eight . 



81 



CONTENTS. XIX 

Case XL — Cutaneous affections — Repeated Attacks of Urethritis — Ap- 
plication of the Nitrate of Silver — Cure . . . .83 

Case XII. — Pruriginous Eruption around the Genital Organs — Two at- 
tacks of Blennorrhagia — Nocturnal and Diurnal Pollutions — Cure 
by means of Sulphuretted Baths . . . . .85 

Case XIII. — Herpes Prseputialis, alternating in a remarkable manner 
with Irritation in the Prostatic Portion of the Urethra — Nocturnal 
and afterwards Diurnal Pollutions — Occasional Impotence — Re- 
establishnient by Cauterization — Relapse — Cure by the Baths of 
Vernet ........ 86 

Case XIV. — Lymphatic Temperament — Various Cutaneous Eruptions 
alternating with other Affections — Habitual bad Health — Hypo- 
chondriasis — Spermatorrhoea undiscovered during Twenty-five 
Years — Cure by Sulphuretted Baths . '. . .88 

Consideration of Causes . . . . .90 

Mode of Action . . . . .91 

Irritation of the Rectum . . . . .92 

Treatment of these Cases . . . . .92 



CHAPTER V. . 

CAUSES OF SPERMATORRHEA CONTINUED. 

Influence of the Rectum . . . . .93 

Case XV. — Spermatorrhoea from a Mechanical Obstacle to Defecation — 

Division of the Stricture — Rapid and Complete Cure . . 93 

Case XVI. — Spermatorrhoea induced by Chronic Diarrhoea, and kept up 
by a Mechanical Obstacle to defecation — Removal of a Schirrous 
Tumour from the anus — Rapid and Perfect Cure . . .94 

Case XVII. — Hemorrhoids from the age of Puberty — Difficulty in evacu- 
ating the Rectum at the age of Twenty-eight — Spermatorrhoea — 
Cure. ........ 97 

Case XVIII. — Blennorrhagia, Constipation — Fissure of the Anus — Dis- 
charge of Semen at Stool — Profound Hypochondriasis — Desire of 
committing Suicide — Diarrhoea — Cure of the Fissure of the Anus 
— Disappearance of the other Symptoms . . . .98 

Case XIX. — Horse Exercise — Constipation — Spermatorrhoea — Impo- 
tence — Frequent and violent Attacks of Cerebral Congestion — As- 
cending Douches — Cauterization — Sulphur Baths — Hot and Cold 
Douches on the Loins and Perineum — Cure . . .100 

Case XX. — Lengthened exposure to severe Cold — Incomplete Paralysis 
of the Rectum — Seminal Discharges during Defecation — Cure by 
the application of Galvanism . . . . .105 

Case XXI. — Intemperance — Lengthened exposure to Cold — Chronic In- 
flammation of the Bladder — Involuntary Seminal Discharges, &c. 
— Cauterization — Cure — Relapse — Same Treatment with the 
same Result — Remarkable influence of the Bladder on the Rectum 108 

Case XXII. — Unsuspected Spermatorrhoea — Attacks of Cerebral Conges- 
tion — Disorder of the General Health — Ascarides expelled from 
the Rectum, with immediate Recovery . . . .111 



XX CONTENTS. 

Case XXIII. — Masturbation at Nine Years of Age — Constant Nocturnal 

Emissions — Ascarides — Cure in Eight Days . . .113 

Case XXIV. — Hypochondriasis — Impotence — Attacks of Cerebral Con- 
gestion — Ascarides. Cure within Eight Days . . .114 

Case XXV. — Nocturnal Pollutions resisting all modes of Treatment during 
Six Years — Great Physical and Moral Depression — Expulsion of 
Ascarides with complete Relief „ . . . .114 

Case XXVI. — The habit of Masturbation contracted spontaneously at 
the age of Fifteen, and continued until the age of Twenty — Noc- 
turnal and Diurnal Pollutions — Increasing Disorder of the Health 
until the age of Twenty-nine — Frequent and prolonged Erections. 
Pain at the Margin of the Anus. &c. — Cauterization performed 
without Benefit — The expulsion of Ascarides followed by rapid 
Recovery ... . . . . . .117 

Case XXVII. — Masturbation at the age of Fifteen — Serious Disorder — 
The application of a Blister followed by Involuntary Nocturnal 
Emissions — Cauterization, Douches, &c, unsuccessful — Expul- 
sion of Ascarides followed by a rapid Recovery . . .119 

Remarkable case of Urethral Discharge kept up by Ascarides. 

— Editor's note to page .... 121 

Case XXVIII. — Masturbation at the age of Ten — Seminal Emissions 
produced by Horse Exercise — Nocturnal, and afterwards Diurnal 
Pollutions — Constant Erections — Stools Relaxed, and containing 
abundance of Mucus — Burning at the Anus — Cauterization, with 
slight Benefit— Expulsion of Ascarides followed by rapid and 
complete Recovery . . . . . .123 

Resume ....... 125 



CHAPTER VI. 

CAUSES OF SPERMATORRHOEA CONTINUED. 

Abuse 126 

Case XXIX. — Masturbation — Nocturnal Pollutions — Palpitation and 
Dyspnoea simulating Cardiac Disease — Repeated Venesection fol- 
lowed by increased Disorder — Sulphuretted Baths and rapid Re- 
covery ........ 126 

Case XXX. — Masturbation at the age of Eight Years — At Twelve, very 
frequent Emissions of Urine — At Sixteen, Coitus Impossible — Noc- 
turnal and afterwards Diurnal- Pollutions — Cauterization at the 
age of Twenty-eight, followed by rapid Recovery . . 127 

Case XXXI. — Masturbation at the age of Seventeen, carried so far as to 
cause emission of Blood, but soon afterwards abandoned — In- 
creasing Debility during Four Years — Symptoms of Phthisis 
Laryngea and Chronic Gastritis — Extreme Prostration — Cauteriza- 
tion followed by rapid re-establishment .... 

Case XXXII. — Masturbation from Twelve to Twenty-one Years of age 
— Melancholy — Inclination to Suicide — Serious alteration of the 
Health — Monomania — Unpereeived Diurnal, Pollutions — Cauteri- 
zation followed by perfect Recovery . . . .13 



130 



CONTENTS. 



XXI 



Case XXXIII. — Abuse caused by sleeping on the Belly — Effects of 
reading Erotic Works — Power of Habit — Alteration of the intel- 
lectual and moral Faculties — Impotence — Chronic Irritation of the 
Bladder — 'Nocturnal and Diurnal Pollutions — Cauterization fol- 
lowed by prompt Recovery . . . . .135 

Case XXXIV. — Sexual ideas at the age of Eight — Abuse at thirteen — 
Various diseases in consequence, until the age of Thirty-two— 
Nocturnal and Diurnal Pollutions — Cauterization — Slow ; but pro- 
gressive Improvement . . . . . .137 

Case XXXV. — Masturbation at Sixteen Years of age — At Twenty one, 
compression of the Urethra during Ejaculation, followed by a 
sensation of tearing, and acute pain — Urethral Discharge recur- 
ring frequently — Discharges of Semen during Defecation and the 
emission of Urine — Reciprocal Influence of the Discharges on the 
Digestive Organs — Chronic Catarrh of the Bladder — Cauterization 
— Recovery after several Relapses . . . .139 

Causes of Abuse ...... 142 

Internal or Pre-disposing Causes .... 143 

External or Exciting Causes .... 143 

Varieties of Abuse ...... 148 

Effects of Abuse . . .- . . .153 

Effects on Children and on Females . . . 155 

Effects of Temperament, Idiosyncrasy, &c. . . . 158 

Urethral Discharges following Abuse . . .158 

Prostatis . . . . . . .159 

Cystitis ..... . . 159 

Emissions of Blood ...... 159 

Orchitis . . . .'",'. .159 



CHAPTER VII. 



CAUSES OF SPERMATORRHOEA CONTINUED. 

Venereal Excesses . . . . . . 161 

Case XXXVI. — Nervous Temperament — Excessive Intercourse at the age 
of Twenty-one, continued during Eighteen Months — Increasing 
Derangement of Health — Symptoms of Gastritis, and of disease of 
the Heart — Repeated Abstraction of Blood— Nocturnal and after- 
wards, Diurnal Pollutions- Milk Diet, &c. — Acupuncture followed 
by perfect Recovery . . . . . .161 

Case XXX VII. — Robust Constitution — Venereal Excesses continued till 
the age of Twenty-four — Chronic Inflammation of the Bladder — 
Nocturnal and Diurnal Pollutions — Cauterization followed by per- 
fect Recovery . . . . . . .165 

Case XXXVIII. — Three attacks of Blennorrhagia — Hypochondriasis — 
Danger of Suicide — Recovery — Marriage a few months after — 
Change in the moral Faculties — Disordered Digestion — Consti- 



XX11 



CONTENTS. 



pation — Agitation — Insomnia — Fits of Passion — Symptoms of 
Mental Derangement — Impotence — Nocturnal and Diurnal Pol- 
lutions — Cauterization followed by rapid Recovery — Excesses 
Repeated — Relapse . ..... 166 

Case XXXIX. — Strong Constitution — Masturbation at the age of Seven- 
teen — Serious disorder of the Health until Twenty-six — Marriage 
— Rapid Improvement — Gradual Relapse after Three Years, not- 
withstanding the cessation of Coitus — Seminal Discharge during 
Defecation and the emission of Urine — Hypochondriasis — Inflam- 
mation of the Genito-urinary Organs — Cauterization — Rapid and 
complete Cure ....... 170 

Case XL. — Sanguineous Temperament — Masturbation from Fourteen to 
Eighteen Years of age — Marriage at Nineteen — Immediate im- 
provement in the Health — Afterwards disorder of the System — 
Hypochondriasis — Inclination to Suicide — Symptoms of Chronic 
Gastritis treated for Six Years with Leeches. Blisters, &c. — Noc- 
turnal and Diurnal Pollutions — Frequent Discharge of Urine — 
Cauterization followed by rapid and complete Cure . . 172 

Case XLI. — Nervous Temperament — Delicate Health — Masturbation be- 
fore Puberty — Urethral discharge after Sexual Intercourse — Or- 
chitis — Nocturnal Pollution s — Absolute Impotence — Injection 
with Solution of Nitrate of Silver unsuccessful — Cauterization fol- 
lowed by rapid Cure ...... 173 

Case XLII. — Masturbation — Venereal Excesses — Prolonged Horse Ex- 
ercise — Blennorrhagia — Nocturnal and Diurnal Pollutions — Two 
Cauterizations — Recovery — Premature Excesses — Relapse — Cure 
by another Cauterization . . . . 175 

Case XLIII. — Lymphatic Temperament — Early and Long continued 
Masturbation— Horse Exercise — Infrequent Coitus — Urethritis — 
Repeated attacks of Inflammation in the Testicles — Frequent dis- 
charge of Urine — Pollutions during Defecation — Imperfect Ejacu- 
lation — Two Cauterizations followed by perfect Recovery . 177 

Case XLIV. — Lymphatico-Sanguineous Temperament — Coitus when 
nearly intoxicated, at the age of Twenty-two — Blennorrhagia — 
Pollutions during Defecation — Disturbance during Ejaculation — 
Band in the membranous portion of the Urethra — Cauterization — 
Cure by means of An tiphlogistics and Rest . . . 180 

Case XLV. — Coitus in a state approaching Inebriety — Gleefincreased by 
a Journey — Diurnal Pollutions — Cauterization with rapid Improve- 
ment — Relapse from premature fatigue of the Organs — Cure by 
means of Antiphlogistics and Rest .... 182 



Resume ...... 


. 183 


Characteristics of Yenereal Excesses 


. 184 


Age . . . ... 


. 187 


Temperament . 


. 187 


Genital Instinct . 


. 188 


Differences of Genital Development . 


. 188 


Influence of Encephalic Organs 


. 188 


x\ccidental Influences 


. 191 


General Effects of Venereal Excesses 


. 192 


Special Effects of Yenereal Excesses 


. 192 



CONTENTS. XXU1 



CHAPTER VIII. 

CAUSES OF SPERMATORRHEA CONTINUED. 

Action of certain Medicines .... 196 

Astringents . . . . . .196 

Case XLVI. — Intermittent Fever — Large Dose of Bark— Obstinate Con- 
stipation — Diurnal Pollutions — Symptoms of Chronic Gastritis, and 
of Disease of the Heart — The use of Douches followed by rapid 
Improvement . . . . . . ,196 

Purgatives . . . . . . . 197 

Narcotics . . . . . . . 198 

Case XLVII. — Frequently repeated Narcotism at the age of Sixteen 
from the Vapour of Tobacco — Dilatation of the Pupils — Vomiting 
— Constant Headache — Constipation — Nocturnal and Diurnal Pol- 
lutions — Impotence — Cauterization at the age of Nineteen — Kapid 
Recovery . . . . . . . .198 

Case XL VIII. — Nervous Temperament — Repeated Narcotism from 
Smoking between the ages of Twenty and Twenty-two — Impo 
tence, &c. . . • . 

Cantharides 
Camphor 



Nitrate of Potass 

Ergot of Rye 

Coffee • . 

Case XLIX. — Excessive use of Coffee — Frequent and profuse Discharge 
of Urine — Nocturnal and afterwards Diurnal Foliations — Impo 
tence, &c. ; — Cauterization — Sulphuretted Baths — Recovery 

Tea ...... 



200 

201 
202 
202 
203 

203 

204 

205 



CHAPTER IX. 

CAUSES OF SPERMATORRHEA CONTINUED. 

Action of the Cerebro-spinal System . . . 20(> 

Case L. — Masturbation — Extreme weakness of the Limbs and Senses — 
Erections excited by Percussion of the Occiput — Catheters left in 
the Urethra — Rapid Recovery ..... COT 

Case LI.— Sickly Childhood — Nervous Temperament — Masturbation 
Rare — Coitus still more so — Symptoms of Aneurism and Gastri- 
tis— Nocturnal Pollutions— Predominance of Erotic [deas — Ten- 
sion at the Nucha — The application of cold Lotions to this Region 
followed by considerable Improvement .... 208 

Action of the Spinal Cord . . * . . .211 



XXIV CONTENTS. 



CHAPTER X. 



CAUSES OF SPERMATORRHEA CONTINUED. 

Congenital Predisposition ..... 212 

Sebaceous Matter ...... 213 

Case LII. — Natural Phimosis — Frequent Nocturnal Pollutions from the 
age of Puberty — Abundant and Fetid sebaceous Secretion between 
the Gians and Prepuce — Circumcision at the age of Twenty-three 
followed by immediate Relief . . . . .213 

Natural Phimosis ...... 214 

Case Lfflv — Natural Phimosis — Erections at the age of Eight — Attempts 
at Coitus at Nine — Vesical Catarrh — Diurnal Pollutions — Para- 
plegia, &c. ....... 214 

Case LIV. — Very long Prepuce — Badly developed Genital Organs — 
Childhoocl Delicate — Incontinence of Urine — Sebaceous Discharge 
from the Orifice of the Prepuce at the age of Ten — Nocturnal 
Pollutions increasing in frequency — Hypochondriasis — Loss of 
Memory and failure of Intellect — Constipation — Diurnal Pollu- 
tions — Constant application of Lotions attended by Relief — Cir- 
cumcision at the age of Twenty-eight, followed by Cure . . 217 

Case LV. — Very long Prepuce — Badly developed erectile Tissues — 
Abundant Secretion of Sebaceous Matter — Seminal emissions in- 
duced by Horse Exercise, and afterward, by incomplete Inter- 
course — Marriage unconsummated during Five Years — Diurnal 
Pollutions — Circumcision followed by rapid Cure . . 219 

Exuberant Prepuce ...... 220 

Abundant and vitiated Secretion of Sebaceous Matter . 221 

Congenital Debility . . . . . .224 

Case LVI. — Relaxed Genital Organs — Spermatic Cords Varicose — Few 
but debilitating Nocturnal Pollutions — Opposite effects of Coitus 
— ITnsuspected Diurnal Pollutions — Constant Headache— Dis- 
ordered Senses — : Intellectual Debility — Hallucination — Tonic 
treatment at the age of Twenty-one, followed by Recovery . 224 

Varicocele ....... 227 

Case LVII. — Hypospadias — Impotence — Frequent Seminal Discharge . 228 

Case LVIII. — Atrophy of one Testicle at the age of Eight — Nocturnal 
and afterwards Diurnal Pollutions — Frequent desires of Micturi- 
tion, &c. . . . . . . .230 

Case LIX. — Lymphatic Temperament — Incontinence of Urine — Neither 
Masturbation nor Sexual Intercourse — More and more frequent 
Nocturnal Pollutions — Relaxation of the Sphincters of the Anus 
and Neck of the Bladder — Treatment Unsuccessful . .231 

Case LX. — Sickly Childhood — Extraordinary Nocturnal Pollutions at 
Sixteen— Sometimes after, Pollutions during Defecation — Ejacula- 
tion impossible — Slow discharge of Semen. after the subsidence of 
Erection — Urethra very slightly Sensitive — Prostatic Surface Hard 
and Cartilaginous ....... 232 



CONTENTS. 



XXV 



Symptoms of Debility of the Genital Organs 

Symptoms affecting the Urinary Organs during Childhood . 

Incontinence of Urine . 

Retention of Urine ...... 

Hereditary Transmission . 

Case LXI. — Blennorrhagia at the age of Twenty-one — Pains in the 
Testicles — Pollutions during Four Years — Serious Gastric and 
Cerebral Symptoms occurring in Paroxysms — Hereditary Predis- 
position — Iced Milk — Cauterization — Acupuncture — Sulphuretted 
Baths — Recovery ....... 

Case LXII. — Nocturnal and Diurnal 

Brothers ...... 

Congenital increased Nervous Susceptibility 

Long-continued Continence . 

General Review of the causes of Spermatorrhoea 



Pollutions occurring in Three 



233 

237 
237 
239 
240 



240 

244 

245 

246 

249 



CHAPTER XI. 








SYMPTOMS OF SPERMATORRHEA. 




Local Symptoms . 


251 


Nocturnal Pollutions 






, , 


251 


Diurnal Pollutions . 






, . 


254 


During Defecation 






, , 


255 


During the Emission of Urine . 






, . 


256 


Appearance of Spermatic Urine 






, 


256 


Other Diurnal Pollutions 






. 


258 


Impotence . 






, 


259 


Diagnosis of Spermatic Urine 






. 


259 


Chemical Analysis . 






. 


260 


Microscopic Examination 






. 


260 


Spermatozoa 






« 


262 


Appearances .on Making Water in a Bath . 




, 


264 


Simplest mode of Detecting the presence of Spermatozoa in 




the Urine 




„ 


, 


266 



2* 



XXY1 



CONTENTS. 



CHAPTER XII. 



SYMPTOMS OF SPERMATORRHEA CONTINUED. 



General Symptoms . 

Infecundity . 

Changes in the Characters of the Semen 

Fever .... 

Symptoms affecting the Digestive Organs 

Symptoms affecting Nutrition 

Animal Heat 

Symptoms affecting Respiration 

Symptoms affecting the Circulation 

Symptoms affecting Innervation 

Mobility 

Sensation 
Symptoms affecting the Special Senses 
Taste .... 

Smell .... 

Hearing .... 
Sight . 

Symptoms affecting the Encephalon 
Sleep and Waking . 
Cephalalgia ..... 
Cranial Congestion . 
Alteration of Character 
Hypochondriasis 

Memory .... 
Intellect .... 
Insanity . . . . . 

General and incomplete Paralysis of the Insane 
General character of the Symptoms of Spermatorrhoea 
Effects of Masturbation on Children and Females 
Progress of the Symptoms . 
Spontaneous Recovery 



CONTENTS. XXVli 



CHAPTER XIII. 



TREATMENT OF SPERMATORRHOEA. 



Pollutions arising from Direct Causes . . . 298 

Pollutions arising from Ascarides . ... . 298 

Pollutions excited by Cutaneous Eruptions . . . 301 
Pollutions arising from altered or increased Secretion of the 

Sebaceous Glands . . * . . 302 

Pollutions depending on Stricture of the Urethra . . 303 

Treatment of the various kinds of Stricture . . . 303 

Pollutions arising from Hemorrhoids . . . 305 
Pollutions caused by Cicatrices in the neighbourhood of the 

Anus . . . . . . .306 

Pollutions caused by Fissure of the Anus . . . 306 

Pollutions produced by Constipation . . . 307 



CHAPTER XIV. 

TREATMENT OF SPERMATORRHEA CONTINUED. 

Pollutions caused by Relaxation and Debility . . 309 

Pollutions arising from increased Nervous Susceptibility . 313 

Acupuncture ...... 315 

Pollutions kept up by Habit .... 316 

Pollutions caused by Sleeping on the Back . . . . 316 



CHAPTER XV. 

TREATMENT OF SPERMATORRHOEA CONTINUED. 

Pollutions caused by Irritation or Chronic Inflammation . 317 
Diet . . . . . . .318 

Cauterization . • . 819 



XXVI11 CONTENTS. 



Action of the Nitrate of Silver . . 323 

Cauterization in Chronic Vesical Catarrh . : . 324 

Deviation of the Orifices of the Ejaculatory Canals . . 325 



CHAPTER XVI. 

TREATMENT OF SPERM ATORRHCEA CONTINUED, 

Convalescence ...... 326 



PRACTICAL TREATISE 



CAUSES, SYMPTOMS, AND TREATMENT 



SPERMATORRHEA 



CHAPTER I 

INTRODUCTION. 

Involuntary discharge of the seminal fluid presents itself under 
various conditions, which differ much in their respective degrees of 
importance. 

When it occurs spontaneously during sleep in a healthy and con- 
tinent individual, it doubtless exerts a beneficial influence on the eco- 
nomy by freeing it from a source of excitement, the prolonged accu- 
mulation of which might derange the animal functions. In these 
cases it has an effect analogous to that produced by the epistaxis, 
common and beneficial during youth. But the discharge may become 
excessive, or, from the condition of the parts, it may outlive the state 
that excited it; then, like repeated nasal hemorrhage, it gives rise 
to inconveniences proportioned to its frequency, its quantity, and the 
constitution of the individual. Involuntary seminal emissions may 
be caused by too great excitement of the genital apparatus, following 
venereal excesses or masturbation. A state of irritation remains in 
the spermatic organs after such excitement, which induces an increased 
secretion and hurried discharge of the secreted fluid, without com- 
plete erection, and almost without sensation. Lastly, the relaxation of 
the ejaculatory canals accompanying this state of irritation, may allow 
the expulsion of the semen without either erection or enjoyment, and 
this takes place especially during defecation and the expulsion of 
the urine. The transition between these different stages of seminal 
evacuation is sometimes so insensible, that it is impossible for the 
patient, or even for the medical attendant, to specify its exact period. 

Every extreme evacuation of the spermatic secretion, in whatever 
3 



34 INTRODUCTION. 

manner caused, is capable of producing the same effects on the sys- 
tem. The different species of spermatorrhoea need not therefore be 
separated either in theory or in practice. 

Ordinary nocturnal emissions are easy of diagnosis and of cure ; 
I shall therefore pass them over, and only treat of those evacuations 
which are sufficiently serious to iujure the health, or which are con- 
nected with discharges not ordinarily perceived. 

I shall use the expressions diurnal and nocturnal pollutions, be- 
cause involuntary discharge of the spermatic secretion certainly oc- 
curs during the night without erection and without pleasurable sen- 
sations, as well as in consequence of lascivious dreams after sunrise. 
Neology is only to be excused when used for the prevention of errors ; 
and I think no one will be deceived respecting the meaning of these 
expressions, which, indeed, are at present generally understood. 
In order, however, to avoid the repetition of many words, I shall 
express, by the term spermatorrhea, every excessive spermatic 
evacuation, from whatever cause it may arise. 

Diurnal pollutions are not always, as is generally believed, the 
result of venereal excesses, or of vicious habits. Many other varied 
causes, whose influence may be single, successive, or simultaneous, 
also give rise to them. 

Some of these causes are already understood, but of many others, 
the medical world is completely ignorant; and these are the most 
dangerous, because their influence is the most difficult of appreciation. 

In all sciences the study of causes is the most important and the 
most difficult. This is true of medicine, and especially of the affec- 
tion forming the subject of this work; for it is principally from the 
cause of the spermatorrhoea, that we learn its therapeutic indications. 
It is true that we must also, in each. case, take into account the parti- 
cular condition of the genital organs, and the constitution of the indi- 
vidual; but these considerations are of little importance with respect 
to the treatment to be employed, and it is especially in a practical 
point of view, that I wish to consider this disease. In consequence 
of not having properly distinguished its causes, explanations, as often 
false as true, have been published respecting spermatorrhoea, and 
modes of treatment have been recommended, whose general appli- 
cation has been sometimes useful, but more often injurious. 

It is, however, of great importance to study attentively the symp- 
toms of involuntary spermatic discharges ; they are little known, very 
varied, and capable of simulating a host of other affections; but their 
character is independent of the first cause of the disease, and they 
furnish few indications for the regulation of its treatment. 

On the other hand, the history of this affection is so much in its 
infancy, that I feel the necessity of proceeding as if I were treating 
an entirely new subject. I shall, therefore, relate many single cases, 
before I attempt to arrive at general conclusions. As these cases are 
very numerous, I must classify them according to some arrangement, 
and I shall place the causes first in this classification, since they are 



INTRODUCTION. 35 

the most important part of it. Proceeding from the evident to the 
doubtful, and from the simple to the compound, I shall examine first 
the causes whose action is most direct and undoubted; and whilst 
studying the influence of each cause, I shall bring forward the cases 
in which its action has been energetic, isolated, and, when possible, 
proved by post-mortem inspection, and I shall afterwards cite cases 
in which several causes have acted successively or simultaneously. 

After having examined many cases in this manner, I shall make a 
general resuiiit, in the course of which, I shall comment on whatever 
relates to the symptoms of the treatment. 

I shall also pay attention to the analogous phenomena which may 
be observed in the female. 

I propose then to consider this affection of the genital organs in all 
its varied phases ; I shall pass rapidly over what is already known ; 
I shall, on the contrary, insist on the most remarkable errors, and 
comment fully on all that may seem doubtful or obscure. 

If I were to relate all the cases that have come under my notice, 
tiresome repetitions would result: I shall, therefore, choose only those 
which best show the characteristic features of the most important 
distinctions, 1 



1 1 have thought it advisable, on account of the great number and length of these 
cases, to select a few of the most striking only. In answer to a communication from 
me on this subject, M, Lallemand has favoured me with the following observation. 
"As regards the cases, their number may be reduced, now that facts are being daily 
multiplied in confirmation of those I have related ; it will be sufficient for you to give 
the most characteristic."'-- [U. I. M'P.] 



( 36 



CHAPTER II. 

INFLAMMATION OF THE SPERMATIC ORGANS. 

Pathological Anatomy, 

Inflammation of the organs for the secretion and excretion of 
semen, is the most frequent and most active cause of spermatorrhoea. 
The influence of this cause may be very easily conceived, and its 
traces may be detected in the organs after death; I shall therefore 
commence the subject by its consideration. 

"Works on pathological anatomy have hitherto afforded us very 
little information respecting this important and delicate matter; the 
omission arises from several circumstances. 

Inflammation of the spermatic organs does not threaten life at its 
commencement; when the patient dies at an early period of the af- 
fection, it is in consequence of some other more serious disease, 
which engrosses the care of the attendants, so that after death ex- 
amination of the spermatic organs is neglected. 

When the continued influence of this inflammation produces diurnal 
pollutions sufficiently serious to destroy life, the periods of their oc- 
currence are very distant; the symptoms are insidious, and their 
true cause, in many cases, is not even suspected. Whatever the 
care taken, then, in examining the body, it generally happens that 
every part is inspected except the genital organs ; incomplete cases 
are thus published, which arc received with the more confidence be- 
cause the dissection of the viscera, generally, has been made with care. 

The situation of the prostate and seminal vesicles is another rea- 
son why their examination is neglected. In order to inspect these 
parts with the minute care requisite, it is necessary to divide the 
crural arch near its centre, to remove the abductor muscles of the 
thighs, to cut through the horizontal rami of the pubes, and the rami 
of the ischia, so as to remove the testicles, the vasa deferentia, the 
rectum, and the perineum undisturbed. 

It is by this means only that we can obtain a good view of the or- 
gans situated in the lower part of the pelvis, examine their relations 
with care, or observe their colour, consistence and dimensions — cir- 
cumstances requiring attentive study — since serious symptoms may 
follow almost imperceptible lesions. Thus, for instance, the orifices 



INFLAMMATION OF THE SPERMATIC ORGANS. 37 

of the ejaculatory ducts may have been rendered uneven by some 
slight ulceration; their form may have been altered, or their size in- 
creased, of which I have met with several cases ; and we can easily 
conceive the consequences which may result from even the partial 
destruction of their little sphincter muscles. The colour, firmness, 
and exact size of these canals also furnish information of much im- 
portance. 

The examination of all these parts requires considerable time, pa- 
tience, and skill; it is necessary to inspect them thoroughly, in order 
to appreciate all changes affecting them, and this is impossible if the 
removal of that portion of the pelvis, to which they are attached, be 
omitted. Thus the section I have described becomes in a measure 
indispensable; nevertheless, in general practice it is never had recourse 
to, except for the purpose of examining some rare affection of the 
bladder or prostate. In order to understand, thoroughly, the condi- 
tions of these parts when diseased, it is necessary, also, to have seen 
them very frequently while healthy : this is neglected even by men 
who devote themselves specially to the study of pathological anatomy. 
On this account I shall illustrate their pathological changes by some 
cases which would under other circumstances be devoid of interest. 



CASE I. 

Blennorrliagia- — Diurnal pollutions — Hypochondriasis — Chronic affection of 
the Brain and its Membranes-^-Death. 

Autopsy. — Right kidney in a state of suppuration— Prostate nearly de- 
stroyed — Ejacidatory ducts idcerated— Seminal vesicles altered. Nothing 
remarkable in the other organs. 

In the month of January, 1824, 1 was requested to see M. t)e S -, 

affected with symptoms of cerebral congestion, from which he had suffered 
for some time. During several consultations I gathered the following facts. 

M. De S was born in Switzerland, of healthy parents, and his father 

died suddenly of affection of the brain. M. De S -, possessing a strong- 
constitution and an active mind, received an excellent education, and at an 
early age turned his attention to the study of philosophy and metaphysics ; 
he afterwards studied moral philosophy and politics. 

After having spent some years in Paris pursuing his favourite subjects, 
he was obliged to undertake the management of a manufactory, and to at- 
tend to details which wounded his pride. He became, by degrees, peevish 
and capricious — passed, without apparent cause, from an extravagant gaiety 
to a profound melancholy — was irritated by the slightest contradiction — 
showed no pleasure at fortunate events — and gave way to anger on improper 
occasions : at length he appeared to feel disgust and fatigue at correspondence 
or mental exertion. 

At this period he married, and Dr. Butini, of Geneva, his medical attend- 
ant and friend, wrote respecting him as follows :— 

"With this marriage the most happy period of his existence seemed to 



38 INFLAMMATION OF THE 






commence; but soon the germs of the disease, which so many causes had 
contributed to produce, became rapidly developed. It was perceived that 

M. De S wrote slowly and with difficulty, and his style presented signs 

of the decay of his faculties; he stammered and expressed his ideas very im- 
perfectly; he experienced, also, at times, attacks of vertigo, so severe as to 
make him fall, without, however, losing sensibility, or being attacked by 
convulsions." 

One day an attack which frightened the patient seriously, and left a deep 
impression on his family, came on whilst writing an ordinary letter. His 
medical attendants attributed his attack, which left a weakness of the right 
side of the body, to apoplexy. Twenty leeches were applied to the anus, 
and the danger seemed at an end. 

Similar attacks, however, occurred at Geneva and Montpellier, and seve- 
ral distinguished practitioners were consulted : some of these, struck by the 
misanthropic irritability of the patient, and his solitary habits, regarded the 
affection as purely hypochondriacal or nervous; others, taking into consider- 
ation his digestive disorder, considered it an affection of the liver; but the 
greater number were of opinion that there existed a chronic affection of the 
brain, such as encephalitis, or chronic meningitis, arising from hereditary 
predisposition. This last opinion was held by Dr. Bailly, (of Blois.) 

At all these consultations, the necessity of abstaining from serious occu- 
pation, the utility of travelling — of various amusements, and of a strict re- 
gimen — and the importance of free evacuations from the bowels by means 
of purgatives and injections — were agreed on. Many of the practitioners 
recommended the frequent application of leeches to the anus, with milk 
diet, &c; others thought that assafoedita, baths, and camphor, were indi- 
cated. 

None of these modes of treatment produced any considerable amendment; 
the leeches weakened the patient, and the milk diet disordered his stomach. 
His constipation continued. Cold plunge baths, and cold affusion to the 

head, relieved the insupportable spasms M. De S experienced in his legs 

and face : the waters of Aix, in Savoy, and the use of douches also appeared 
to produce some improvement. 

Still M. De S — — became more irritable, and at the same time more 
apathetic. His attacks were more frequent and more violent, and he mani- 
fested greater indifference towards the persons and things he had before been 
partial to. The weakness of his limbs increased to such an extent that he 
frequently fell, even on the most level ground. His nights were restless, 
his sleep very light and often interrupted by nervous tremors, or acute 
pains accompanied with cramp. The cerebral congestion increased, and the 
imminent fear of apoplexy rendered leeches to the anus, venesection in the 
foot, tartar-emetic ointment, blisters, mustard pediluvia, and the application 
of ice to the head, necessary. 

Notwithstanding the employment of these energetic measures, another 
violent attack of congestion, occurred. I was summoned on this occasion, 
and I found the patient restless, agitated, and incapable of remaining two 
minutes in the same place; his face was red, his eyes projecting, injected, 
and fixed; his physiognomy expressed extreme dread; his walk was uncertain, 
his legs bending under the weight of his body; his skin cold, and his pulse 
small and slow. 

The last circumstance attracted my attention, and I also recommended 
the application of leeches to the anus. M. De S immediately threw 



SPERMATIC- ORGANS. 39 

himself into a violent passion, and asserted that leeches had always weak- 
ened him without giving him any relief. I was too much afraid of the oc- 
currence of apoplexy to pay attention to this assertion, and I succeeded in 
obtaining the application of six leeches. 

The next day I found the patient very pale, and so weak that he was un- 
able to walk — a source of much annoyance to him, as he manifested a con- 
stant desire for motion. An oedeniatous swelling of the parotid gland and 
of the right cheek followed, which was succeeded, a few days after, by a si- 
milar state of the left leg and foot. 

Sleep had become indispensable, and the patient was much reduced from 
the want of it; he told me, with tears in his eyes, that he had lost his appe- 
tite, and could no longer relieve his bowels. I also learned that he was ha- 
bitually costive and flatulent; that he often had recourse to injections and 
purgatives in order to relieve his obstinate constipation ; and, lastly, that his 
walks, and the evacuation of his bowels had lately become the sole objects of 
his thoughts and conversation. 

Having observed analogous symptoms in almost every person affected by 
diurnal pollutions, I made further inquiries respecting the attack, in which it 
was supposed that the right side had been paralyzed, and I was soon con- 
vinced that the intellectual powers had been wanting, and not the power in 
the hand which held the pen : both sides of the body had, in fact, retained 
an equal degree of strength. 

Struck by a remark of Dr. Butini's respecting the progress of the disease 

soon after marriage, I made inquiries of Mine. De S , and learned that 

the character of her husband had become so uncertain, irritable, and tor- 
menting, that his friends thought he must be unhappy in his marriage. I 
then suspected that the origin of the patient's disease had been mistaken, 
and I requested that his urine might be kept for my inspection. The ap- 
pearance of the urine was sufficient to convince me that my suspicions were 
well founded ; it was opaque, thick, of a fetid and nauseous odour, resembling 
that of water in which anatomical specimens have been macerated. By 
pouring it off slowly, I obtained a flocculent cloud, like a very thick decoc- 
tion of barley ; a glairy, ropy, greenish matter remained, strongly adherent 
to the bottom of the vessel, and thick globules of a yellowish white colour, 
non-adherent, like drops of pus, were mixed with this deposit. I was there- 
fore convinced that spermatorrhoea existed, together with chronic inflamma- 
tion of the prostate and suppuration in the kidneys. 

Notwithstanding the state of M. De S 's intellect, I was able at a fa- 
vourable moment to obtain further information. At the age of sixteen he 
had contracted blennorrhagia ; this he carefully concealed, and succeeded in 
curing by the use of refrigerant drinks. The following year the blennor- 
rhagia returned, and was removed by astringents. Two years afterwards, 
from drinking freely of beer when heated, the discharge again appeared, and 
after some time it again returned, from the effects of horse exercise. Since 

that time, M. De S had felt little sexual desire, and had abstained 

from intercourse without regret. Ejaculation during coitus had always been 
very rapid. Fully convinced by combining all these circumstances, I ex- 
plained to M. De S the nature of his disease, and he promised me to 

observe carefully. 

The next day he called me aside, and told me that the last drops of urine 
were viscid, and that during an evacuation of the bowels, he had passed a 
sufficient quantity of a similar matter to fill the palm of his hand. 



40 INFLAMMATION OF THE 

Eight days after, another attack of cerebral congestion occurred, fol- 
lowed by stertorous breathing, cold skin, and an inappreciable pulse; the 
patient fell into a kind of syncope, of which he died on the 1st of March, 
1824. 

Post mortem inspection, twenty-six hours after death. — The 
general emaciation of the body was extreme. 

Head. — Between the dura mater and the arachnoid several bubblesof 
air appeared, mixed with a viscid serosity; the vessels of the pia mater 
were slightly injected; the arachnoid was a little opaque near the falx, 
but neither thickened nor granular; two or three spoonfuls of limpid se- 
rum were found in the ventricles, without any apparent alteration in their 
serous lining; the brain was slightly injected and soft throughout, but with- 
out appreciable alteration in any one particular part; the cerebellum, also, 
was very soft, of natural size, neither more nor less injected than the brain, 
and without any particular alteration. Three or four spoonfuls of serum 
were found at the base of the brain and commencement of the vertebral 
canal. 

Chest. — Pleura pulmonalis every where adherent by a dense cellular tis- 
sue to the pleura costalis; lungs crepitant and pale, except at the posterior 
part; heart of the ordinary size, and firm. 

Abdomen, tympanitic, green, and exhaling a very fetid smell; liver of 
natural colour and very firm ; a spoonful of bile in the gall bladder ; spleen 
small and of a violet colour ; stomach distended by gas ; mucous membrane 
thin, soft, and of a brownish gray colour; small and large intestines equally 
distended by gas, pale, and thin in their structure, containing a small quan- 
tity of brown, excessively offensive liquid, faecal matter. 

Left Kidney of the ordinary size, of a healthy red, and very firm. 

Right Kidney a third larger than natural, adherent by a dense, resistant 
cellular tissue to the surrounding structures; containing in its parenchyma 
about forty little abscesses, varying from the size of a pea to that of a nut, 
some of recent formation, and without cysts, others old and encysted, all con- 
taining thick and creamy pus ; the structure of the kidney reduced in four- 
fifths of its extent to a dense coriaceous membrane, full of cloacae ; the lining 
membrane of its pelvis red and villous ; the ureter thin, distended, brownish, 
and much injected on its mucous surface. 

Bladder rising as high as the umbilicus, and containing two pints of trans- 
parent urine. Its parietes thin; the muscular fibres weak and scattered; 
mucous membrane rose-coloured and slightly injected, but thin and scarcely 
altered in appearance. 1 

Prostate projecting three or four lines behind the neck of the bladder, 
over about an inch and a half in superficial extent. In the Trigone Vesicle 
there was an effusion of albuminous matter, half a line in thickness and 
about two inches in extent, uniting the seminal vesicles to the anterior wall 
of the rectum. 

The Left Seminal Vesicle small and brown, but in its normal position. 

TJie Right separated from the corresponding vas deferens, folded on the 
posterior border of the prostate, atrophied and surrounded by a very dense 
fibrous cellular tissue, which was very difficult of dissection. 



1 In order to examine the genital organs with greater care, I removed the parts 
with the rectum, by means of the section before described. 



SPERMATIC ORGANS. 41 

The Prostate double its normal size, and projecting into the rectum; 
hard on the sides of the neck of the bladder, soft in the centre. Its fibrous 
envelope having been divided with a bistoury, an opaque, thick, ropy, 
elastic matter escaped, like pus in colour, and the mucus of the nostrils in 
consistence. There was a cavity occupying the whole of the anterior and 
middle parts of the prostate, about fifteen lines in size in every direction, 
when the purulent matter had been removed; the gelatinous mass was 
observed to divide into a number of filaments which became impacted in 
numerous small foramina; the canal of the urethra being closed, these 
filaments came out by the openings of the mucous follicles of the prostate. 
When this cavity was emptied it became evident that the two inferior 
thirds of the prostatic part of the urethral mucous membrane had been 
detached and had covered the cavity in the prostate in the same manner 
that the cribriform lamella of the ethmoid bone covers the nasal fosste in the 
dried skull. 

The openings of the Ejaculatory Ducts, in place of being circular and 
nipple-shaped, formed a long slit, which was ulcerated, especially on the 
side towards the bladder; two probes of considerable size introduced 
through the vasa deferentia passed easily through these openings. The 
ejaculatory ducts were long and thin, as though dissected, and formed part 
of the superior wall of the cavity in the prostate. The posterior border of 
the prostate was not destroyed, but was pale, soft, and easily torn, like all 
the parts in the neighbourhood of the principal abscess. 

The Urethra presented no remarkable appearances. 

The Testicles were small, flaccid, and pale. 

I leave this case just as I wrote it when under impressions formed 
at the time, because its recital is well fitted to show those serious 
errors in diagnosis which are much more common than might have 
been suspected. 

Now that we have seen the more obscure parts of this case cleared 
up by degrees, let us consider the chronological order of the facts : — 

A urethral discharge, badly treated in the beginning, reappeared 
from very slight causes, whose action, however, was easily appre- 
ciable. The follicles of the prostate, from repeated attacks of inflam- 
mation, became disorganized; the ejaculatory ducts were laid bare, 
and their orifices became ulcerated; the inflammation extended to 
the seminal vesicles, and the peritoneum adjoining. 

Soon after, a new train of symptoms set in, which became much 
aggravated after the patient's marriage, in consequence of the unac- 
customed exercise of the disordered organs. Ejaculation was rapid, 
because the ejaculatory ducts were in a state of irritation. The 
erections were incomplete, and at length ceased altogether, because 
the semen was habitually expelled as soon as secreted. This dis- 
charge was considerable, for the testicles shared the irritation of the 
other parts. During all this time inflammation was creeping along 
the urinary apparatus, and ended by destroying the right kidney. 
Hence the symptoms observed previous to death; hence the very 
remarkable appearance of the urine, an excretion to whose changes 
sufficient importance is not attached at the present day, from its exa- 



42 INFLAMMATION OF THE 

urination having been once rendered ridiculous through the preten- 
sions of quacks. 

CASE II. 

Blennorrhagia — Spermatorrhoea — Hypochondriasis — Frequent attacks of 
cerebral congestion — Death. 

Autopsy. — Suppuration in the seminal vesicles — Ossijic deposit in the vasa 
defer entia — Cystitis — Phlebitis — Old adhesions of the arachnoid and 
pleurce — Abscesses in the muscles of the neck and shoulders. 

On the 25th of September, 1825, Professor Brousonnet granted me the 
examination of one of his patients who was supposed to have died from 
cerebral hemorrhage. Before commencing the post mortem I learnt the fol- 
lowing particulars : — 

Francis Maurice, aged seventy-three years, formerly a soldier, had com- 
plained for some time of weakness in his legs; he staggered whilst walking 
as if he suffered from giddiness, and he would often have fallen if he had 
not been assisted. Occasionally he had attacks of congestion in his head; 
his face became red, he lost his senses, and experienced very varying spas- 
modic symptoms. After these his face became pale, and fainting occurred. 
These attacks had been treated by bleeding, derivatives, antispasmodics, and 
leeches. 

At length, on the 22d of December, a violent attack of congestion in the 
head occurred; his face became purple, and the next day he died. 

These symptoms seemed to indicate a chronic affection of the brain or its 
membranes, producing attacks of congestion, the last of which terminated 
in apoplexy. On inquiry I could not learn which side of the body had 
been paralyzed; but it seemed certain that no distortion of the face had 
ever existed. This circumstance made me suspect that the paralytic symp- 
toms had always been general. 

The cause of the disease was attributed to some hidden care. The pa- 
tient had spoken little, and always presented a sad and silent appearance : 
he had complained of a host of different diseases, the greater number of 
which seemed imaginary, or, at least, much exaggerated. He complained 
of pain about the occiput, the neck, and the back; colic, distention of the 
lower part of his belly, and borborygmi affected him frequently. Notwith- 
standing his weakness he had a constant desire for motion: he could not 
remain quiet in bed, and often had recourse to the night-stool. He had an 
irritable manner; he tormented the nurses and snubbed the pupils, and was 
generally looked upon by the latter as a hypochondriac. 

I learnt also that he had experienced several attacks of retention of urine, 
and I recollected having introduced a catheter for him a few days before his 
death. 

I suspected, therefore, that the symptoms he had manifested arose from 
unperceived spermatorrhoea. 

The following are the results of the inspection of the body : — 

Head. — Cerebrum and cerebellum slightly softened throughout, but not 
more so in one part than in another; the cerebral substance slightly, but 
equally, injected, especially in the posterior lobes; several old cellular adhe- 
sions, five or six lines in extent, in the inferior occipital fossae, intimately 
uniting the corresponding surfaces of the arachnoid; the cerebellum equally 



SPERMATIC ORGANS. 4-3 

adherent to the pia matter in the same situation, and incapable of being de- 
tached without injury to its structure. In the other parts of the interior of 
the cranium there was not the least local change that could be considered a 
result of recent disease. 

Thorax. — Lungs healthy; a few old adhesions of the pleurae on both 
sides ; heart flaccid, of the colour of wine lees, and easily torn ; the principal 
veins without firmness, and of a dark violet colour; the iliac and crural veins 
presented the same conditions. 

Abdomen, — The mucous membrpne of the stomach slightly injected; the 
small intestines in much the same state; nothing remarkable in the other 
abdominal organs; the kidneys and ureters healthy. 

Pelvis. — The bladder, which contained a large quantity of muddy urine, 
was united to the rectum by cellular adhesions; its mucous membrane was 
of a dark red, highly injected, and covered by small ecchymoses, from ex- 
travasation of blood in its structure; the prostate was of its natural size and 
firmness. 

The Seminal Vesicles were much dilated, their parietes were very thick 
and dense, and they presented no markings or inequalities. These organs 
were attached by strong and much injected cellular tissue to the neighbour- 
ing parts, and each of them contained about a spoonful of thick yellowish 
pus enclosed in three or four cavities communicating with each other and 
with the ejaculatory ducts. The inner surface of these abscesses was un- 
even, rugous, and lined by a sort of false membrane formed by a layer of 
thickened pus. 

The Yasa Deferentia were tortuous, and completely ossified for the extent 
of about three inches, but not obliterated. They contained a slightly viscid 
fluid. 

The mucous membrane of the urethra was much injected, especially from 
the bulb as far as the bladder; the mucous follicles much developed. The 
neck of the bladder was thickened, of a reddish brown colour, without te- 
nacity, and fissured by several recent lacerations. 

Some days after, the pupils, who were dissecting the muscles of this sub- 
ject, told me that they had found the subscapularis, and the supra- and infra- 
spinatus muscles on both sides, as well as several muscles of the neck, in a 
state of suppuration. 

Some time after I succeeded in learning the following facts. 

Maurice whilst in service at the age of twenty-three years contracted a 
violent blennorrhagia accompanied by orchitis and inflammation of the spongy 
tissue of the urethra, which he neglected after the relief of the most urgent 
symptoms. His character, previously very gay, now changed by degrees; 
he experienced attacks of profound melancholy, during which he imagined 
that every one disliked him; when these attacks were over he gave himself 
up to dissipation; he drank freely, but when no longer excited he relapsed 
into melancholy, and often complained of pains in his head towards the oc- 
ciput. 

At first he experienced nocturnal pollutions, and soon after he perceived 
that in evacuating his bowels, especially when costive, he sometimes had a 
spermatic discharge. By degrees his digestion became much disordered, 
constipation became habitual, and the spermatic discharges at stool in- 
creased. He reformed and gave up drinking : his health was, however, 
ruined; he took cold easily, and suffered from pain in his side and frequent 
pains in his limbs and loins; he was constantly tormented by flatulence, 



44 INFLAMMATION OF THE 

colic, and diarrhoea or obstinate constipation. His legs were weak, and his 
body was frequently affected with tremors; yet he could not remain in bed, 
he was tormented night and day by a constant desire for motion, and being 
very weak he frequently fell. 

After some time he had difficulty in supporting his head, and he complained 
of a constant pain in his neck and shoulders, accompanied by tenderness in 
the vertebral column. The evacuation of urine, previously irregular and dif- 
ficult, now became often impossible without the aid of a catheter. 

Latterly, he became subject to frequent attacks of cerebral congestion, 
during which his face was purple ; he was insensible, convulsed, and appeared 
to be threatened with an attack of apoplexy. The practitioner, called under 
these circumstances, never failed either to bleed from the arm, or to apply 
leeches, and as the attack did not last long, he attributed its relief to the ab- 
straction of blood. Immediately afterwards, even when bleeding had not 
been practised, the patient remained exceedingly pale ; and at the close of 
one of these attacks he died. 

The same causes produced the same effects in this, as in the pre- 
ceding case ; the same symptoms led to the same errors in diagnosis : 
it was just as difficult to discover the truth, and the same appear- 
ances were found after death. Cases of this nature are not then so 
rare as might have been expected. 

Supposing that in these two cases, we had proceeded to examine 
the bodies, with the pre- convictions arising from an observation of 
the symptoms ; it is clear we should have found nothing in the cranial 
cavity, which would have accounted for the cerebral symptoms, for a 
general and uniform softness of the cerebral matter is observed after 
all chronic diseases, especially when decomposition has made any 
progress ; it is evident also that we should have found nothing more 
satisfactory in the other viscera : who knows, then, to how many 
errors these observations might not have given rise ? 

Among the cases cited by the believers in nervous apoplexy, and 
special spasmodic affections, I am convinced that a great number arise 
from spermatorrhoea; but, from the non-examination of the genital 
organs, it has been impossible hitherto to prove the correctness of 
this opinion. I trust that soon all practitioners will be able to avoid 
such errors. But let us reconsider the case of Maurice : — at the age 
of twenty-three he had urethritis, accompanied by chordee and or- 
chitis. As soon as the worst symptoms were relieved, he resumed 
his old habits, and gave himself up to excesses of all kinds. By 
degrees his health failed under the influence of nocturnal, and af- 
terwards of diurnal pollutions ; he became hypochondriacal, and not- 
withstanding his forced abstemiousness, he at length died in the same 
state as M. De S . 

Why did this patient resist the action of the disease longer than 
the first ? Because the alterations were much less serious, and even 
the state of the pus found in the prostate seemed to announce that 
the inflammation had taken on an acute character, only during the 
last stage of the disease. 






SPERMATIC ORGANS. 45 

Can diurnal pollutions, sufficient to destroy life, exist at the age of 
seventy-three years ? Undoubtedly they can, since the vasa defe- 
rentia still contain, at this age, a viscid secretion, consisting of badly 
formed semen ; besides, the patient had told his friends, shortly before 
his death, that in going to stool he had passed semen in the palm of 
his hand. 

I have before said that Maurice passed for a hypochondriac, and 
that his diseases were considered imaginary, or at least very much 
exaggerated ; nevertheless, we found, in various organs, recent and 
old changes, to which we must refer his complaints. 

By degrees, as his health broke up, he became more easily affected; 
he complained of pains in his side — his lungs were attached to the 
walls of the chest by cellular adhesions; he often complained of pains 
in the head, fixed towards the occiput — the cerebellum was found ad- 
herent to the meninges at several spots, at the same time that the 
membranes were attached to each other: latterly, he complained of 
constant pains in the neck and shoulders — the subscapularis and su- 
pra- and infra-spinatus muscles of both sides, together with several 
muscles of the neck, were found in a state of suppuration : the pa- 
tient was subject to attacks of retention of urine — the neck of the 
bladder, together with the urethra and vesical mucous membrane, 
were thickened, and of a brownish red colour. 

I ought to add, that the principal abdominal, and even the femoral 
veins, were softened, and of a violet hue, and presented traces of 
phlebitis. 

We see, therefore, that most of the disorders of which Maurice 
complained depended on so many really existing local inflamma- 
tions. 

I know that many of the symptoms experienced by patients af- 
fected with spermatorrhoea are purely nervous, and that we find often 
after death, no trace of alteration in the organs which had been sup- 
posed to be diseased; but I also know how the majority of post- 
mortem examinations are conducted. 

We forget that the slow and progressive weakening of the consti- 
tution, following disordered digestion, causes an increased nervous 
susceptibility in hypochondriacs ; and that a less energetic resistance 
of the different organs to the action of causes capable of altering 
their health also results from it; hypochondriacal patients are thus 
much more liable to every disease, at the same time that they suffer 
more from the diseases affecting them. 

A few words more on the other lesions : the vasa deferentia were 
ossified in several points : this ossific deposit was not the effect of 
age, as might be supposed, for I have met with it under similar cir- 
cumstances in very young subjects : it must, therefore, be attributed 
to old standing inflammation. 

In the orchitis that follows blennorrhagia, the inflammation extends 
from the mucous membrane of the urethra to the testicles, by the 
ejaculatory ducts, seminal vesicles, and vasa deferentia; the latter 



46 INFLAMMATION OF THE 

are almost cartilaginous in their normal conditions ; in chronic in- 
flammation, therefore, they may easily become encrusted with phos- 
phate of lime. 

The neck of the bladder was fissured by several recent splits. 
When the internes requested me to catheterize this patient, it was be- 
cause they had been unable to enter the bladder. I learnt that they 
had always used the smallest instruments ; by, on the contrary, using 
the largest I could find, I reached the bladder without difficulty. 



CASE III. 



Blennorrliagia — Retention of Urine, &c. — Apoplexy — Death. 

Autopsy. — Effusion of Blood into the left ventricle of the train — Hyper- 
trophy of the heart — Gastro-enteritis — Abscess and tubercles in the kidneys 
and prostate — Stricture, &c. 

Gojon, at the age of forty, contracted an acute blennorrhagia, with 
orchitis. Treated by irritating medicines, which produced diarrhoea and 
violent colic, it diminished, but did not entirely disappear, a slight urethral 
discharge continuing for ten years, with pain in the prostatic region and fossa 
navicularis. He was also annoyed by obstinate constipation. Between the 
ages of fifty and sixty he experienced difficulty in discharging his urine, a 
feeling of uneasiness in the urinary apparatus, weakness of the body, diffi- 
culty of digestion, considerable loss of flesh, and a remarkable diminution in 
his intellectual powers. Still later he had frequent attacks of retention of 
urine, successfully treated by baths and demulcents, intolerable pain in the 
kidneys and bladder, hypochondriasis, a strong aversion to frequent places, 
melancholy, and serious debility. 

On the first of February, 1827, retention of urine occurred, for which 
leeches were applied to the perineum, and general baths and demulcents 
were employed without relief; active inflammation of the perineum and 
cellular tissue of the scrotum took place, for which fomentations were ap- 
plied. 

On the 5th the skin of the perineum gave way in three places, and a large 
quantity of urine mixed with pus was discharged. 

On the 10th of February this patient was brought to the hospital. He 
was sixty-five years of age, his skin was warm, and his pulse full and strong; 
cheeks red, eyes watery, with pain under the orbits; ideas pretty clear, 
tongue red and dry, severe thirst and a desire for cold drinks; abdomen sen- 
sitive on pressure, especially in the hypogastric region; attempts at catheterism 
unsuccessful. ' Fomentations were ordered to the abdomen. 

On the 11th an attack of apoplexy occurred, and on the 12th he died. 



POST MORTEM APPEARANCES. 

Head. — Considerable effusion of florid blood in the left lateral ventricle. 
Chest. — Lungs crepitant. Hypertrophy of the left ventricle of the heart. 
Abdomen. — Mucous membrane of the stomach red throughout its whole 



SPERMATIC ORGANS. 47 

extent; covered by little spots of ulceration scattered here and there; the 
injection of the intestines becoming more and more remarkable in the 
neighbourhood of the anus. Some ulceration in the rectum. 

Genito-urinary organs. — From ten to twelve abscesses were found in 
each kidney; and in the left, crude tubercles, about the size of a bean, ex- 
isted. The ureters were dilated, and their lining membrane red and in- 
jected. Bladder hardened- and columnar, an inch in thickness. Mucous 
membrane of a violet colour, thick, soft, and ulcerated in several points. 
Prostate three times its normal size; more developed under the neck of the 
bladder than towards the rectum; furnishing, by pressure, a very abundant 
purulent discharge, and containing about thirty little abscesses and as many 
crude tubercles. This prostate resembled the tissue of a lung full of tu- 
bercles, of which some are empty, others suppurating, and others immature. 
The seminal vesicles and vasa deferentia thickened. 

There was a circular stricture in the urethra, about half an inch in front 
of the prostate, formed by a tissue of a horny consistence, and scarcely per- 
mitting the introduction of a No. 2 catheter. An enormous dilatation of the 
urethra was observed between the stricture and the neck of the bladder, and 
the mucous membrane of this portion of the canal was thickened, fungous, 
and softened, and presented in its posterior part a fissure whence three 
fistulas took their origin. 

The cellular tissue of the perineum and scrotum was full of pus. The 
testicles were healthy. 

This patient died the day after his entry into the hospital, and . 
during this short space his state had not permitted us to think of in- 
voluntary spermatic discharges, always very difficult to detect in cases 
of this nature. The stricture was, however, seated a little in front of 
the orifices of the ejaculatory ducts, and the prostatic mucous mem- 
brane was disorganized by inflammation ; nothing is more common 
than spermatorrhoea under these circumstances. On the other hand 
the prostate was considerably altered, and the seminal vesicles and 
vasa deferentia were much thickened. It is then to be presumed that 
the loss of intellect, the great debility of the system, &c, arose, as 
in the preceding cases, from habitual spermatic discharges. 

Death was caused by a large effusion of blood in the left lateral 
ventricle. Was the hemorrhage the result of one of those cerebral 
congestions of which we have spoken in the preceding cases ? Ana- 
logy seems to indicate that it was. 

Hypertrophy of the left ventricle of the heart was present, how- 
ever, and the influence which the increased development of this 
organ exercises on the brain is well known. If this hypertrophy 
were not the sole cause of the effusion, it had, without doubt, a large 
share in producing it. In obscure questions like that which occupies 
us we must only admit facts that are incontrovertible, and we must 
resist as much as possible the attraction of pre-conceptions. I have, 
therefore, reported this case, because it confirms what I have stated 
respecting the facility with which inflammation of the mucous mem- 
brane of the urethra extends to all the other mucous membranes 
connected with it. 



48 INFLAMMATION OF THE 



be- 



The first disease was urethritis with orchitis. Thus, at the 
ginning the inflammation extended from the urethra to the testicles 
by their excretory ducts, and the manner of this extension cannot be 
doubted, because twenty-five years afterwards the vasa deferentia 
and vesiculae seminales were still thickened. The extension of the 
inflammation in the direction of the urinary passages was still more 
evident, for not only the prostatic mucous membrane was thickened, 
fungous, and softened, but that of the bladder was thick and softened, 
also, violet coloured and even ulcerated in several points ; the ureters 
were dilated, and their inner surfaces red and injected; lastly, each 
kidney contained ten or twelve abscesses, tubercles also existing in 
the left. 

The prostate is the principal seat of blennorrhagic discharges ; being 
situated at the junction of the urinary with the genital apparatus, it 
cannot fail to be affected by disorders which extend to tissues very far 
from their points of origin ; thus it was still more diseased than the 
kidneys. It was three times its normal size, and independent of the 
purulent matter furnished by its mucous follicles it contained about 
thirty small abscesses and as many crude tubercles. 

I shall remark, as I proceed, that the circumstances under which 
the tubercles of the prostate and left kidney were developed, and the 
existence of these tubercles by the side of recent abscesses, leave no 
doubt as to the cause of their formation. 

Before concluding these reflections, I must also notice that traces 
of acute gastro-enteritis and even of ulceration of the rectum were pre- 
sent. It is to this complication that we must attribute the redness 
and dryness of the tongue, the extreme thirst, and the sensitiveness 
of the abdomen to pressure — characteristic symptoms of inflamma- 
tion of the digestive organs, which we must not confound with de- 
rangement of their functions, or with the gastralgia that so fre- 
quently accompanies spermatorrhoea; neither must we confound the 
hemorrhage that caused death with the cerebral congestions of which 
I have spoken in the two preceding cases. 

Unfortunately, these distinctions are very difficult to be established 
in some cases, as alterations of tissue often follow purely sympathetic 
functional derangements so suddenly, that it is impossible to specify 
the moment when the affection becomes really idiopathic. This is, 
above all others, the circumstance which has hitherto thrown so thick 
a veil over cases of spermatorrhoea; and which renders the minute 
examination of each case so necessary. 



SPERMATIC ORGANS. 49 



CASE IV. 

Mental derangement — Belief in a change of sex. — Death. 
Autopsy. — Thickening of the arachnoid — Great alteration of the prostate 
— Atrophy and obliteration of the ejaculatory ducts. 

I find the following particulars related by Professor Rech respecting an 
insane person who died under his care. "The intellect had been disordered 
for a long time; the patient believed he had changed his sex, and, thinking 
himself a woman, spent much of his time in writing to an imaginary lover : 
sometimes he fell on his knees and seemed to dig the ground for hours to- 
gether. He had entirely lost the power of vision in the left eye. His death 
took place from exhaustion after an obstinate diarrhoea. At the post-mor- 
tem inspection, the dura mater was found healthy throughout; the arach- 
noid was thickened in several points, and opacities were found on its sur- 
face which obscured its transparency. The pia mater contained a consi- 
derable quantity of serosity, especially between the cerebral convolutions. 
The brain, cerebellum, and medulla oblongata were healthy in all their 
parts. The optic nerve of the right side was atrophied behind the commis- 
sure to the extent of half an inch, of a grayish colour and very soft. In the 
left eye, the retina was separated from the choroid by a considerable serous 
effusion; the vitreous humour, apparently atrophied, formed a reddish and 
irregular mass. The lungs and heart were healthy, but the latter was 
remarkable for its small size. 

"The mucous membrane of the intestines, from the coecum downwards, 
was red and thickened ; and this alteration increased in intensity near the 
rectum, in which numerous ulcerations existed. 

"The prostate projected into the bladder, and was nearly two inches in 
extent in its long, and fifteen lines in its transverse diameter; its structure 
contained three small abscesses. The ejaculatory ducts were softened, atro- 
phied, and obliterated. The vasa deferentia, and the vesiculae seminales were 
on the contrary larger than ordinary." 

The patient died of a chronic diarrhoea, and the intestinal mucous 
membrane was injected, thickened, and ulcerated; he had lost his 
power of vision in the left eye, and this eye was extensively altered, 
as was also the right optic nerve, before its entering the optic com- 
missure; he believed himself to be a girl, and the functions of the 
testes must have been abolished, since the ejaculatory ducts were 
atrophied and obliterated. If this singular alteration of the genital 
organs were not the cause of the patient's derangement, it must at 
least have influenced its peculiar character. 

SUMMARY OF THE PRECEDING OBSERVATIONS. 

Symptoms. — In the first two patients only, were involuntary sper- 
matic discharges discovered, and their general symptoms well de- 
scribed. The other cases are hardly of importance, except in respect 



50 INFLAMMATION OF THE ' 

of their pathological illustrations. It is only in the first two cases 
that the progressive deterioration of the spermatic organs can be 
well followed, from the first blennorrhagia to the patient's death; 
and that the ever increasing influence of spermatorrhoea over the 
whole economy, but especially over the cerebrospinal system, can 
be appreciated. 

The delusions produced in both patients by the last class of symp- 
toms are well fitted to open the eyes of practitioners as regards cases 
of this nature. The consequences resulting from them in a thera- 
peutic point of view are so serious, that we cannot well attach too 
much importance to their due consideration, 

But how can extreme cases of spermatorrhoea so closely simulate 
affections of the brain, or of its membranes ? and by what charac- 
ters can we distinguish their symptoms from those arising from idio- 
pathic affections of the same organs? In order properly to discuss 
questions of this kind, it is indispensable to have before us all the 
facts influencing them; but in passing, we may hastily consider 
those with which we are already acquainted. 

In the first two cases, the cerebral symptoms were preceded, during 
a long period, by a remarkable derangement of the other functions: 
thus, digestion was performed badly ; the stomach no longer bore 
fermented drinks, spiced meats, or very nutritious food ; stubborn 
constipation supervened ; the intestinal tube was habitually distended 
by flatus ; sexual intercourse became more and more rare, the act 
more rapid, and at last entirely impossible. The patients, in these 
cases, discontented with themselves and their friends, and tormented 
by flatus, of which they want continually to relieve themselves, shun 
society and its trammels ; they dislike every thing which recalls to 
them pleasures they are unable to share ; they become melancholic 
and irritable, misanthropic and hypochondriacal ; ever occupied by 
the consideration of their health, they manifest the utmost indiffe- 
rence for all things which do not affect it. 

The cerebral functions are not more weakened than all the rest, 
but their disorder produces more serious consequences, and is more 
readily perceived. It is soon remarked, that memory becomes im- 
paired, that the train of thought is easily interrupted, and that the 
least excitement of the intellect induces congestion towards the 
head. Diflicult digestion, more obstinate constipation, and abdomi- 
nal distention by flatus, supervene in these cases, which end by at- 
tacks of congestion in the fatigued and weakened brain. 

But these congestions are accompanied with a remarkable feeble- 
ness of the pulse, chilliness of the limbs, general uneasiness, anxiety, 
agitation in every sense, and a remarkable desire for motion. They 
are immediately followed by pallidity of the countenance, general 
debility, and alarming faintness, without any one part of the body 
being more affected than the rest. 

Apoplectic congestions are never preceded for years by a progres- 
sively increasing weakness of the economy; the pulse is full, and 
there is a tendency to drowsiness. 



SPERMATIC ORGANS. 51 

The patient whose case I have related in my third observation, 
died in consequence of an extensive cerebral hemorrhage, which 
came on suddenly in the left lateral ventricle of the brain ; but this 
patient had hypertrophy of the heart, and the first attack promptly 
caused death ; it is, therefore, probable that the congestion was not 
due to the same cause, and it certainly did not present the same 
characters as in the two preceding cases. 

The disorder observed in the ideas of such patients cannot be 
confounded with delirium; whenever delirium has been really pre- 
sent in these cases, true meningitis has been found to exist, of 
which I have seen numerous examples. The state of the intellect, 
in these affections, manifests, perhaps, a greater resemblance to de- 
mency; but demency commonly follows mental derangement; be- 
sides, it is always easy to obtain, in the cases I am considering, 
clear and connected answers. 

It is impossible also to confound the disorder of the digestive func- 
tions with the symptoms of inflammation of these organs ; in all cases 
in which inflammatory symptoms are observed, gastro-enteritis is 
actually present. 

Lesions. — It is chiefly on account of the alterations discovered 
in the spermatic organs that the cases I have hitherto recorded are 
of value. The influence of the urethra on all the organs which 
open into it, is an important phenomenon in the history of sperma- 
torrhoea. To have a clear idea of this influence, it is necessary 
especially to prove the facility with which inflammation creeps along 
the mucous membranes, to even their most distant continuations. 

Prostate. — Blennorrhagic discharge arises from the mucous folli- 
cles of the urethra, and of the prostate especially, where they are 
most developed and most numerous : the prostate, in fact, is formed 
of these follicles, united by cellular tissue. 

During the first days after contagion, a tickling in the urethra 
is felt, with itching heat and pain, especially during the emission 
of urine. The secretion of the canal is increased, and changes its 
appearance, but it is not until the inflammation has reached the 
prostate, that the discharge acquires its greatest severity. It is 
then principally secreted by the prostate, and experienced patients 
seem to be aware of this, for in doubtful cases we see them com- 
press the urethra from the perineum to the glans penis, in order to 
expel the secretion. Besides, post-mortem examinations permit no 
doubt to remain on the subject. 

But the irritating matter which excites the disease is not deposited 
on the surface of the prostate, and it is not because this matter con- 
tains a contagious principle, that the inflammation is propagated so 
rapidly from the orifice of the urethra to the prostatic mucous folli- 
cles, for leucorrhcea, the menstrual discharge, or the lochia, are fre- 
quently sufficient to excite a profuse discharge, the seat of which is 
equally in the mucous follicles of the prostate. 



52 INFLAMMATION OF THE 

It is not the passage of the irritating matter from one point of 
the mucous surface to another, that favours this propagation, for 
the discharge passes from behind forwards, and the inflammation 
extends in the opposite direction. 

However it may arise, the fact is constant, and it clearly explains 
the frequency of prostatic disease as a sequel to blennorrhagia. 

In the beginning of a very acute inflammation, the prostatic folli- 
cles are gorged with a thick adhesive pus, and form a firm and yel- 
lowish body like a scrofulous tubercle; the cellular tissue surround- 
ing them is so far, however, perfectly healthy, so that the follicles 
can be easily separated from one another throughout their extent, 
and the nature and seat of their changes can thus be proved. 

At a more advanced period of the disease, we find the prostate in- 
filtrated with pus or a pultaceous matter, which may be pressed out 
in the form of granules ; the cellular tissue is now, therefore, attacked 
by the inflammation, but suppuration is not yet well established. 

At a still more advanced period, by slightly compressing the pros- 
tate, pus may be made to exude from all its excretory ducts, and it 
contains, besides, little abscesses from the size of a linseed to that 
of a pea. Here the suppuration of the cellular tissue has begun to 
form into distinct collections. 

In the third case I have related, the prostate was three times its 
normal size, and furnished, on pressure, a very abundant purulent 
matter; it contained besides this about thirty little abscesses, and as 
many crude miliary tubercles. We observe here the same progress 
of the inflammation, but the abscesses, in place of discharging their 
contents, were transformed into tubercles by the absorption of the 
fluid parts of the pus. 

In the first case I have reported the prostate was partly destroyed, 
and contained in its fibrous envelope an elastic and purulent matter, 
wlrich passed into the canal of the urethra, through a number of 
foramina in the mucous membrane. These foramina were the orifices 
of the mucous follicles whose parietes had been destroyed by sup- 
puration. 

We see by these observations, then, that the inflammation extends 
from the urethral mucous membrane to that lining the mucous folli- 
cles of the prostate, and afterwards to the cellular tissue uniting 
them ; that abscesses form, and either discharge their contents by 
the mouths of these follicles after having destroyed their parietes, 
or in other cases form tubercles, which end in the same way; that 
the prostate becomes destroyed by degrees, and is reduced to a fi- 
brous envelope, quite perfect, and covered by a kind of perforated 
membrane, the foramina in which vary in form and size, according 
as the excretory orifices remain distinct, or are united together by 
the destruction of the intervening tissue which separates them. 

When the inflammation of the prostatic cellular tissue is less severe, 
in place of pus, an albuminous matter is deposited, which infiltrates 



SPERMATIC ORGANS. 53 

the part and gives rise to indolent engorgement, and if this be not 
dispersed promptly and entirely, induration of the prostate will re- 
sult. I have seen many cases in which this has occurred. 

Spermatic Organs. — The frequency of orchitis arising from blen- 
norrhagia shows with what facility inflammation of the urethra extends 
to the testicles. This extension takes place by means of the mucous 
membrane. Injury, exposure to cold, &c, may indeed favour the 
development of orchitis ; but its principal cause, often its sole cause, 
is the influence of the urethral mucous membrane over that lining 
the excreting organs of the semen. 

Both patients and practitioners are in many cases much puzzled 
to understand the appearance of orchitis, and they would be still 
more so if pre-conceived opinions did not facilitate its explanation. 
Sometimes it is from having walked too far, or from having sat too 
long, sometimes from having worn too tight a pair of trousers, or 
from having bruised the testicles by crossing the legs, that the dis- 
ease has arisen. But who is not exposed to the action of such causes ? 
I admit that it is often immediately after a circumstance of this kind 
that the patient experiences, for the first time, a more or less sharp 
pain in the testicle, which is soon afterwards followed by the other 
symptoms of orchitis ; but those patients who observe carefully never 
fail to remark, that they first experienced a sense of weight in the 
inguinal region, and of dragging and pain in the spermatic cord. 
On examining the cord of the affected side, the vas deferens is then 
found to be swollen and very sensitive, and it even sometimes hap- 
pens that the swelling of the cord is so great as to cause a kind of 
strangulation in the inguinal canal. 

When, afterwards, the inflammation extends to the body of the 
testicle, it is attributed to the first cause which drew attention to the 
morbid sensibility of the organ, and then it is that the urethral dis- 
charge diminishes or becomes suppressed, according as the new in- 
flammation is more or less severe. The suppression of the discharge 
makes the patient imagine that the affection itself has attacked the 
testicle, and many medical men even believe that the suppression 
does give rise to orchitis. They are deceived by taking the effect 
for the cause ; but it is not the less true on this account, that the 
inflammation of the canal has originated that of the testicle ; indeed 
the succession of the symptoms ought to be sufficient to show the 
course the disease has taken. 

When both testicles have been affected, both ejaculatory ducts 
are found altered, and when both seminal vesicles or both vasa defe- 
rentia have been inflamed, the same alteration is remarked in both the 
ejaculatory ducts. When one only of the spermatic organs has been 
inflamed, I have always been able to trace the inflammation to the 
orifice of the corresponding ejaculatory duct, whilst the other has been 
found unaffected. I have also seen the inflammation spread without 
interruption as far as the tunica vaginalis of the testicle or of both tes- 
ticles, according as the disease has extended on one side or on both. 



54 INFLAMMATION OF THE 






This affection of the tunica vaginalis may be easily explained, since 
any alteration of the glandular tissue is readily partaken by its 
fibrous covering, which is intimately united with the serous tissue 
coating the gland. 

Inflammation of the seminal vesicles extends itself in the same man- 
ner, in some cases, to the adjacent peritoneum. In the first case I 
have related this inflammation was quite recent; the matter depo- 
sited on the surface of the serous membrane was still albuminous, 
soft, and unorganized ; and in the second case, the bladder was united 
to the rectum by cellular adhesions, evidently due to the same cause. 

These observations are of greater importance than they appear; 
they prove that general peritonitis might easily arise from the dis- 
eases we have been studying. The old and circumscribed adhesions 
of peritonitis which sometimes line the bottom of the pelvis, ought 
also to be noted as being almost certain proof of old inflammation 
of the seminal vesicles ; they may, therefore, assist much in explain- 
ing the symptoms observed during life, when the alterations of the sper- 
matic organs have passed away, or do not leave any very apparent 
traces. However this may be, these alterations of the peritonaeum 
and of the tunica vaginalis prove that the inflammation is propagated 
by contiguity of tissue. 

But it is necessary to examine a little more in detail the state of 
the different spermatic organs. 

Orifices of the Ejaculatory Ducts. — In the patient who was the sub- 
ject of the first case, the orifices of the ejaculatory ducts, in place 
of being circular, formed one elongated and irregular cleft. The 
ducts themselves were very large. This enlargement has been noticed 
by Stoll 1 in a case related by him ; and it was still more remarkable 
in a body I once saw in the School of Medicine, in which the open- 
ing admitted a goose-quill. In all these cases still more serious 
lesions existed, but it is easy to conceive that the dilatation or ul- 
ceration of the sphincters which terminate the ejaculatory ducts, 
may alone possess great influence over the production of spermator- 
rhoea, and I should not be surprised if we should find sometimes no 
other lesion capable of accounting for it. 

The Ejaculatory Ducts generally share the alteration and dilatation 
of their orifices; besides which, they may be insulated, as though dis- 
sected, by the suppuration of the prostate, or thickened, hardened, 
and cartilaginous, or they may even contain osseous granules. These 
alterations, much more serious than those of their orifices, must dis- 
pose very much to the involuntary escape of the semen. The ducts 
having lost their elasticity, and even their power of contraction, are 
no longer able to drive back the semen into the seminal vesicles ; or 
at least they are incapable of retaining it, however gently these re- 
servoirs may contract, or however little they may be compressed. 

1 Pars prima rationis medendi. 



SPERMATIC ORGANS. 55 

The pressure exerted on these ducts, by the swelled tissue of the 
prostate, may cause their atrophy or obliteration, whence, of course, 
ensues the more or less complete loss of their functions. 

Seminal Vesicles. — It would appear that pus formed in the seminal 
vesicles should be easily expelled ; but these two receptacles, com- 
posed of ramified cells, are placed out of the direct course of the 
semen, to be used as reservoirs for it ; and they only communicate 
with the vasa deferentia and the ejaculatory ducts, by a very narrow 
opening, in front of which the seminal fluid may pass to be discharged 
directly from the testicles to the urethra; it seems that the swelling 
produced by inflammation may so much lessen this opening as to form 
an obstacle to the exit of pus, for a shorter or longer period : in one 
case which I had an opportunity of examining, the pus had acquired 
a considerable thickness, and that at the bottom of the cells was still 
more thickened, exactly resembling tuberculous matter. The resi- 
dence of the pus in this situation may be even still more prolonged, 
should the watery part be more completely absorbed; in these cases 
we find only a yellowish homogeneous substance, soft, like plaster, 
or even chalky, the true origin of which has been entirely mistaken. 

It is almost unnecessary to notice that the presence of pus prevents 
the entrance of the semen into the reservoirs intended for it, and that 
it becomes, from this alone, an immediate cause of spermatorrhoea. 
We can easily understand also that after the expulsion of the pus, the 
parietes of the vesicles must be thickened, and that they may always 
remain hardened, altered in shape, thickened, cartilaginous, or even 
bony. In more favourable cases, also, their lining membrane must 
preserve, during a long time, an abnormal sensibility, the influence 
of which must be very injurious. 

It is not, however, necessary that such serious alterations should 
exist in the seminal vesicles in order to account for the irregular and 
spasmodic contractions of which they are sometimes the seat, or for 
their influence on the production of spermatorrhoea ; but it is useful 
to understand fully the most striking changes, in order the better to 
appreciate the slighter ones. 

The qualities of the semen found in the seminal vesicles should also 
be carefully noticed: I have seen it resemble meconium in one of 
these receptacles whilst pus existed in the other ; and it is probable 
that the alteration of the secretion of the one testicle was due to a 
similar influence which, in the same case, had acted still more evi- 
dently on the opposite organ. 

Vasa Deferentia. — Pus formed in the vasa deferentia is not in 
all cases easily expelled; swelling of their walls may bring about 
complete obliteration of these vessels in one or more points, whilst 
in others they are distended by the accumulation of the pus, so that 
pouches, more or less dilated and separated by contractions, some- 
what resembling irregular chaplets, are formed. This disposition may 
extend itself to the epididymis, and to the corpora Highmoriana, the 



56 INFLAMMATION OF THE 

mucous membranes of which are continuous with those of the vasa 
deferentia at one part, and with those of the secretory tubes at 
another. 

Pus thus separated and submitted for an indefinite time to the ac- 
tion of the absorbents, becomes more and more solid, and gives rise 
to deposits resembling those of tuberculous matter, the aspect and 
consistence of which may present every degree of alteration in the 
same individual, according to the age and size of the abscess. 

From this obliteration of the vasa deferentia, retention of the semen 
in the testicles also results, so that the generative power is lost ; but 
it does not necessarily follow from this that the patients should be 
free from spermatic discharges. If the abscesses of the epididymis 
open externally, we can understand that the semen will escape imme- 
diately through this rupture of the excretory canal, and that in this 
way a true spermatic fistula is formed; and should this take place 
on both sides, it is clear that the patients would be exposed to the 
same phenomena as if they were affected by spermatorrhoea. 

If the obliteration of the excretory canal be not followed hj rup- 
ture, it is probable that the secreting organ after having been a long 
time distended, swollen and painful, will in the end diminish by de- 
grees, and will become completely atrophied, as happens to other 
glands under the same circumstances. Thus certain cases of atrophy 
of the testicles, after very long and painful swelling of them, may be 
accounted for. 

When the vasa deferentia are felt hard and knotty there can be 
no doubt as to the cause of this atrophy; but sometimes the altera- 
tion takes place in parts where manual examination is impossible, and 
in these cases the state of the prostate will be likely to furnish impor- 
tant information : when it is found irregular, swollen, and enlarged, 
the atrophy of the testicles must be regarded as the consequence of 
pressure on the ejaculatory ducts. 

In an officer whose case I treated, the testicles were not larger 
than those of a child of six years; the. patient had experienced a 
continued dull pain in them for a long time ; the prostate was much 
altered; his moral faculties had experienced the same changes that 
occur in cases of spermatorrhoea, but the physical man was not much 
weakened; the reason of this is evident. 

Chronic atrophy of the testicles, following more or less acute pain 
in them, is by no means rare : these pains are usually considered 
nervous, and the insensible wasting which follows them has not been 
as yet satisfactorily explained. All the patients of this kind whom 
I have had an opportunity of observing, had suffered previously from 
blennorrhagia, of which I am convinced this atrophy was the distant 
but direct result. 

We often find the vasa deferentia thickened, hardened, cartilagi- 
nous, or even quite ossified, in patients who have had orchitis. These 
cases confirm what I have stated respecting the mode of transmission 



SPERMATIC ORGANS. 57 

of inflammation from the urethra to the testicles, for all these shades 
of induration are so many results of inflammatory action. 

Testicles. — Every surgeon knows how slowly enlargement of the 
epididymis and corpus Highmorianum, following orchitis, is dis- 
persed. This fact alone is sufficient to prove that it is by the vas 
deferens that the inflammation reaches the testicles, because it is by 
means of the corpora Highmoriana that the secretory tubes open 
into the excretory ducts. It is not then surprising that this part 
of the testicle should be the one most seriously altered, and often 
even the only one affected. 

Purulent collections formed in the testicle are not able, like those 
in the organs we have already considered, to empty themselves by 
the excretory canals, and the fibrous envelope which encloses the 
secretory vessels is very resistant ; it must, therefore, often happen 
that slight and very circumscribed inflammations are arrested before 
suppuration has been able to appear externally. If in these cases 
complete absorption do not take place rapidly, the thicker part of 
the pus may form tubercles, the presence of which will, in its turn, 
be a cause of new inflammation, and the vessels secreting the semen 
may, like the follicles of the prostate, be destroyed by degrees, so 
that the gland may become reduced to its envelope only. Other 
products besides pus may be formed in the cellular tissue of the tes- 
ticle ; when the inflammation is slight but of long duration, or fre- 
quently recurring, a gelatino-albuminous matter is deposited, which 
thickens and becomes a source of organic alterations like those in 
the prostate, and the first cause of these also may be usually traced 
to long-neglected chronic affections of the urethra. 

I have attached much importance to the thorough understanding 
the mode of transmission of inflammation from the urethra to the 
testicles, because the establishment of this point explains in the 
most simple way why the presence of a sound in the urethra, or the 
existence of a stricture, so often excites congestion and inflammation 
of those organs, and even in some cases the development of hydro- 
cele, as well as why the removal of the cause suffices generally to 
make the effect cease. 

The conciliation of all these circumstances is especially of impor- 
tance to the study of spermatorrhoea ; and the intimate connexion of 
the urethra with the testicles by means of the vasa deferentia should 
suffice to forewarn us of the influence which the condition of the 
mucous membrane surrounding the orifices of the ejaculatory ducts, 
must exercise on the secretion and expulsion of semen. 

Urinary Organs. — Analogous phenomena present themselves in the 
organs secreting and excreting the urine. The inflammation extends 
from the urethra to the kidneys by means of the bladder, and ureters ; 
it is even easy to trace its progress, without interruption ; hence the 
violet coloured spots of congestion, the ecchymoses, and even ulce- 
ration of the mucous membrane lining these organs ; hence the swell- 
ing and injection of the kidneys ; hence the abscesses of all sizes and 



58 INFLAMMATION OF THE 

of all stages, encysted and non-encysted, and mixed with crude or 
suppurating tubercles, which have been found in the kidneys. 

As a sequel to these successive attacks of inflammation I have 
seen the tissue of the kidney destroyed like that of the prostate or of 
the testicle ; almost reduced, in fact, to its external fibrous envelope. 

There is then an exact similitude between these two classes of or- 
gans, and if the kidneys could be as easily examined as the testicles 
this resemblance would appear still more strikingly. 

Comparison of the two sets of Organs. — We often see, after expo- 
sure to cold or excessive drinking, a blennorrhagia diminish or cease 
entirely, and the patient experience at the same time violent and 
deep-seated pain in the loins: the urine is scanty, high coloured, 
and sometimes even bloody. If in these cases we could examine 
the kidneys as we do the testicles, we should, perhaps, find that at- 
tacks of nephritis following blennorrhagia are nearly as frequent as 
those of orchitis. 

I am convinced that, in the cases I have seen, alterations of the 
kidneys have been more frequent than those of the testicles. It is 
not only as a sequel to blennorrhagia or stricture that nephritis 
takes place ; every inflammation of the urinary canals may extend 
to the kidneys ; and this is why acute or chronic cystitis, and the 
presence of stone in the bladder, are such common causes of inflam- 
mation of these organs ; this is why the kidneys are so often found 
disorganized when the bladder has been long irritated by the presence 
of extraneous matters, or by repeated attacks of retention of urine. 

I believe I have now more than sufficiently shown how easily acute 
inflammation of the urethra extends to the secreting organs of the 
semen and urine, by means of their excretory ducts ; I have com- 
pared together the phenomena that occur in both classes of func- 
tions, because they are presented at the same time, in very nearly 
the same degree, and with analogous characters. But this resem- 
blance is not observed in cases of acute inflammation only ; it is 
more easily shown in these cases, and on this account I have com- 
menced with their consideration. Similar phenomena are, however, 
observed under the influence of less active causes. 

When the bladder is irritated the secretion of urine is increased in 
quantity and altered in quality; and at the same time that it becomes 
more abundant and more watery, it remains a shorter time in the 
bladder; the desire of micturition is felt oftener and more suddenly; 
however the patient may wish to retain the excretion, the sensation 
is so painful, and the bladder contracts so violently, that the urine is 
often expelled in spite of every effort, and before the patient has had 
time to prepare himself for its discharge. The fluid is passed each 
time in small quantity, the jet is short and feeble, and falls within a 
little distance of the patient's feet : should this state continue any 
length of time, the muscular coat of the bladder becomes more deve- 
loped, the parietes of the organ are thickened, and its capacity dimi- 
nishes in the same proportion. Those who have noticed the coinci- 
dence of this limpidity of the urine with its frequent expulsion, have 



SPERMATIC ORGANS. 59 

concluded that the more watery the fluid secreted the more it irritates 
the mucous membrane. But it is impossible for us to admit that the 
urine should irritate the bladder most when it contains least salts in 
solution. It is evident that the effect has here been mistaken for 
the cause. It is because the bladder is irritable that it cannot longer 
bear the presence of the urine, and this fluid is more watery, because 
the irritable kidneys secrete it in greater quantity, and it remains a 
shorter time in the bladder ; that this view is correct, is proved by 
the vesical mucous membrane, when it possesses its normal sensi- 
bility, submitting for a long time to the presence of a large quantity 
of watery urine, as occurs daily after meals. 

If this irritation be prolonged, it may produce in the end a kind 
of relaxation of the secreting vessels, and degenerate into diabetes. 
The urine entirely loses its chemical characters ; the urea and uric 
acids are replaced by a saccharine matter, and the system wastes in 
consequence of furnishing so superabundant a secretion. 

Exactly the same phenomena are observed in the spermatic organs 
when they are submitted to the influence of a similar irritation ; the 
testicles secrete an increased quantity of semen because they are 
irritated, and their secretion is more watery because it is less per- 
fectly formed, and remains a shorter time in its reservoirs before 
expulsion ; it is more rapidly expelled because the seminal vesicles 
are more sensitive to the impression produced by its presence, and 
are more readily excited to action. 

The spasmodic contractions of which these organs become the seat 
commence by producing ejaculation very rapidly either during sexual 
intercourse or after erotic dreams ; this renders coitus rapid and in- 
complete, and nocturnal pollutions very frequent ; afterwards the 
weakness and irritability are increased, the semen becomes more 
abundant,and still more fluid, and the convulsive contractions of the 
seminal vesicles are more frequent ; during this state the approach of 
a female, or even a lascivious idea may suffice to excite ejaculation ; 
but the semen is no longer projected with energy, erection is never 
complete, and scarcely any sensation accompanies emission. 

These injurious contractions are at last excited even by still less 
distinct causes; the patients feel them come on when least expected, 
they dread their consequences, and still they are quite unable to 
prevent them. Lastly, there are cases in which the debility of the 
genital organs is such that a true spermatic diabetes may be said to 
be present, as well by the, quantity and quality of the secreted fluid 
as by the frequency of its emission. 

We have been unable to make the same chemical experiments on 
the altered semen that have been made on the urine of diabetic 
patients ; but the semen in such cases contains no more spermatozoa 
than the urine does urea. Let it not be thought that this statement 
is founded only on analogy ; the fact really exists in practice. I have, 
at this moment, a patient under my care, who is dying, worn out by 
the effect of diabetes with diurnal pollutions of the same kind. 



60 INFLAMMATION OF THE 

Here, then, we have, from the action of the same causes, the kid- 
neys, testicles, bladder, and seminal vesicles affected in the same 
manner, and producing analogous results ; and further, these affec- 
tions seldom occur singly; thus, in stricture, the urinary passages 
are, indeed, chiefly affected, but I have seen cases in which the 
spermatic organs have been almost as much disordered; it is not in- 
flammation alone which may extend in both these directions, but 
even a simple irritation of the urethral mucous membrane. 

Diurnal pollutions are too little understood to have been generally 
noticed in these cases : they are always obscure, and the attention is 
fixed usually on another object ; but I have so often satisfied myself 
of their presence as a sequel to strictures, that I regard sperma- 
torrhoea as the true cause of all the cases of hypochondriasis, ischuria, 
and debility, which are attributed to affections of the urinary organs. 
This position, is, I think, proved by the weakness and rare occur- 
rence of erection, the rapidity of ejaculation, and the increased 
fluidity of the semen observed in most of these patients. 

Cases of diurnal pollution uncomplicated with chronic catarrh or 
irritation of the bladder are somewhat rare : and this often renders 
diagnosis difficult, not only on account of the symptoms of catarrh 
being present, but also on account of the mucus secreted by the 
bladder and prostate. On this account, when I see the urine cloudy, 
I always inquire respecting diurnal pollutions, so that I may not 
confound mucus with semen. 

It is very remarkable also, that those who give themselves up to 
venereal excesses or masturbation, frequently experience a desire 
to micturate ; this fact gave rise to the saying of the ancients, 
u raro mingitur castus." I have ever been struck by the truth of 
this axiom ; and the fact proves how easily the urinary organs share 
the excitement of the spermatic. 

Another very important circumstance in the history of diurnal 
pollutions proves how correct is the analogy I have established be- 
tween irritation of the bladder and that of the seminal vesicles. It 
is almost always at the end of the emission of urine that the semen 
escapes ; the bladder then contracts forcibly to expel the last drops 
of urine, and the seminal vesicles also enter into action, and expel 
with the urine a greater or less quantity of their contents. 

It has been wrong to attribute this viscid discharge to the prostate, 
because it does not present all the qualities of ordinary semen; the 
evacuation is sometimes very abundant, and that it is semen, cannot, 
in these cases, be mistaken. Besides this, when the patients have 
their attention called to the circumstance, they know very well how 
to estimate the contractions of the seminal vesicles, which are even 
in general proportion to the extent of the evacuation. 

Most patients remark also that when they are threatened with a 
relapse, it is preceded by a more frequent and very sudden desire to 
micturate, whether this increased sensibility of the bladder arise from 
cold or from an excess either of drink or of coitus. This proves that 
the same causes act at once on both sets of organs. 



SPERMATIC ORGANS. 61 

Persons affected by diurnal pollutions experience, generally, 
injurious effects from the use of diuretics. Nearly all those who have 
taken squills, nitrate of potass, digitalis, &c, have noticed during 
their use a remarkable increase of the seminal evacuations, and a 
few, after having been cured during a longer or shorter period, have 
experienced relapses which could not be attributed to any other cause, 
and which have spontaneously passed off as soon as they have re- 
linquished the use of these medicines. 

It is also well worthy of notice that children subject to inconti- 
nence of urine, are particularly liable to nocturnal pollutions at the 
age of puberty; and at a later period to diurnal pollutions. 

Lastly, I cannot conclude this parallel of the two sets of organs 
without mentioning that obliteration of the spermatic excretory 
ducts may be followed by the formation of spermatic fistulse, in 
the same manner that strictures of the urethra give rise to urinary 
fistulas. 

To resume: — All the mucous surfaces of the genito-urinary organs 
have the greatest analogy and the most intimate connexion with one 
another. It is by them that inflammation creeps by degrees to the 
secreting organs of the urine and of the semen. The portion of this 
membrane which lines the prostate, being in intimate connexion with 
that of the mucous follicles, with that of the ejaculatory ducts, and 
with that of the bladder — this portion then is the one, the different 
conditions of which have most effect on all the rest. This connexion 
takes place by means of the lining membrane of the ducts ; and is 
by no means to be considered the result of sympathy, such as exists 
between the uterus and breasts. 

The excretory canal, transmitting the inflammation, must neces- 
sarily share its influence. The seminal ducts and vesicles, then, 
cannot remain unaffected by the action they transmit to the testicles, 
and this is an important consideration when we recollect that these 
are as much the acting organs in the emission of semen, as the blad- 
der is the organ for the expulsion of urine. 

We shall often find it necessary to apply these facts to the study 
and treatment of diurnal pollutions, and in passing, it is as well to 
notice that the influence of the excretory canals on the secreting 
organs is not an isolated phenomenon occurring only in the kidneys 
and testicles, but that it is the result of a general law, applicable to 
all glands. 

Suction excites the secretion of milk and changes its qualities ; 
the first drops drawn from the nipple are watery, and the milk af- 
terwards becomes more abundant and better formed in proportion 
as the suction continues. The introduction of extraneous bodies 
between the eyelids increases the lachrymal secretion, which some- 
times even is so changed, that it irritates and excoriates the skin 
of the cheeks. The presence of food in the mouth, especially when 
spiced and savoury, increases the secretion of the salivary glands. 
During digestion the liver and pancreas are excited j and the 



62 CAUSESOF 

use of emetics and purgatives produces the same effects. The 
ejaculatory ducts open on the surface of the prostatic mucous mem- 
brane; is, then, the important part this membrane plays in the pro- 
duction of spermatorrhoea, a cause for wonder ? 



CHAPTER III. 

CAUSES OF SPERMATORRHOEA. 

Blennorrhagia. 

The first case of diurnal pollutions which I had occasion to treat 
occurred in a student of medicine, twenty years of age, who studied 
his disease with much care, and described its causes and symptoms 
with remarkable perspicuity. The following are the facts : — 

CASE V. 

Lymphatic temperament — Blennorrhagia — Orchitis — Nephritis — Koctu r- 
nal and diurnal pollutions — Abuse of mercurials — Injurious effects of 
cold and tonics — Cure by means of leeches, the use of flannel, and milk 
diet — Fresh attack of Blennorrhagia — Same treatment, with the same 
result. 

M. N — — , of lymphatic temperament, tall and thin, with a pale face, red 
hair, white, and habitually cold skin, narrow chest, and soft, feeble voice, 
had never suffered from any diseases except those about to be described. In 

January, 1821, M. N contracted blennorrhagia, which was treated by 

emollient drinks, general baths, and corrosive sublimate. In the month of 
April, several doses of ChopartV mixture were taken, and arrested the dis- 
charge, after a duration of four months. Six weeks afterwards he con- 
tracted a second blennorrhagia, and in September, swelling of the left tes- 
ticle occurred after horse exercise. This swelling was in a great measure 
dispersed, but a flaccid state of the scrotum remained, causing painful drag- 
ging pains in the spermatic cords, which were relieved, however, by the 
use of a suspensory bandage. At the commencement of 1822, the dis- 
charge, still continuing, local astringents and mercurial frictions were em- 
ployed, with iodide of potassium and bichloride of mercury internally. 



' The following is the composition of Chopart's mixture : 
R Balsam copaib., 

Alcoholis, sp. gr. 33°, 

Syrupi simplicis, 

Aq. menth. pip., 

Aq. fior. anrant., aa partes sexaginta, 

Sp. aether, nitr. partes octo ; 
M. ft. mist, cujus cochlear, minim, unum nocte maneque sumend. 



SPERMATORRHEA. 63 

Under this treatment the discharge diminished, hut did not entirely disap- 
pear. 

"Whilst taking these remedies, M. N was exposed to severe cold. 

Cutaneous exhalation was suppressed, and pain in the loins supervened. 
This was generally of a dull character, but was rendered acute on the 
least exposure to cold; about the same period M. N 's digestion be- 
came impaired. He attributed this to weakness of the stomach, and sought 
to stimulate the organ by a generous diet, and by the use of rhubarb and 
wine. These means, however, only increased his disorder, and, about the 
month of June, 1822, it became very serious. As soon as food reached 
the stomach he felt an impression at the praecordia, with difficulty of breath- 
ing, general lassitude, and sometimes a desire to vomit; his tongue was 
white and pasty; his bowels constantly distended with flatus, and he suf- 
fered from obstinate constipation, with occasionally slight fainting fits; 
he was quite unable to fix his attention on any subject requiring mental 
exertion. 

Although without appetite, he forced himself to eat to keep up his strength, 
but his digestion became more difficult, and he felt himself much overcome 
by lassitude after meals. He endeavoured to assist digestion by the use of 
coffee, and with the same view he bathed every morning in cold water; he 
was, however, unable to remain immersed more than a quarter of an hour at 
a time without shaking in all his limbs ; no reaction took place afterwards, 
and he always remained a long time before he was able to regain a comfort- 
able degree of warmth. He obtained relief from eating ices, however, and 
took them frequently. 

A slight urethral discharge still continued, and on waking in the morn- 
ing he perceived a viscid pearly matter at the orifice of the glans. Part of 
this matter, remaining in the canal, was expelled with the urine, and re- 
mained suspended in the fluid like a cloud, which after some time was de- 
posited on the bottom of the utensil. 

Towards the close of the year 1822, when the cold weather commenced, 
his bad symptoms increased; he became sad and absent, was unsettled, with- 
out fixed motives, and very timid. He became shivered on the least expo- 
sure to cold, the rigour commencing in the lower extremities, and extending 
over the whole body. He suffered severe pains in the loins, and passed 
urine frequently, and he now had difficulty in expelling the last drops, which 
were viscid and always partly passed on his shirt. He no longer had erec- 
tions or sexual impulse. He often passed semen during sleep, without las- 
civious dreams or any turgidity of the penis, and he constantly felt an irre- 
sistible drowsiness. Towards the commencement of 1823 he perceived an 
abundant reddish sediment in his urine. 

About the end of February his state had become deplorable : he then ap- 
plied to me, and I ordered the following treatment — twelve leeches to the 
anus, cold lotions to be applied to the scrotum and perineum three times a 
day, iced milk, flannel next the skin, very little wine to be taken with his 
meals, and, after a short time, complete abstinence from all fermented liquors. 
A few days after he felt a remarkable change ; his digestion was performed 
better; the pain in his loins and the lassitude disappeared. He became 
less sad, less timid, and he applied himself to study with ardour ; his genital 
organs acquired energy, and he threw aside his suspensory bandage; his 
urine no longer deposited a sediment, and erections re-appeared. Leeches 
were applied a second time, fifteen days after the first, and he continued 



64 . CAUSES OF 

the remainder of the treatment for two months. By that time — about the 
end of April — his health was re-established, and the warmth of summer 
proved sufficient to confirm it. In the month of July, 1823, however, he 
contracted a third blennorrhagia which did not affect his general health. A 
month after its appearance it was treated successfully by means of leeches 
and small doses of copaiba : but when he took the latter in too large quan- 
tities, he suffered acute pain in the loins. Sea bathing during the month of 

September contributed much to strengthen his genital organs. M. N 

was afterwards appointed, by concours, senior surgeon to a very important 
hospital, which proves that he was able to apply himself, after his recovery, 
to severe study. I have since seen him several times, and have learnt that 
his health continues excellent, but that he is obliged to guard carefully 
against the effects of cold, and against every over excitement of the diges- 
tive organs. He finds it necessary every winter to return to milk, with mild 
and light food, and to drink water with his meals. 

This patient while suffering under blennorrhagia used horse exer- 
cise ; soon afterwards orchitis occurred ; painful dragging sensations 
were experienced in the spermatic cords, even for along time after the 
abatement of the inflammation. It was then by the vas deferens that 
the inflammation was transmitted from the mucous membrane of the 
urethra to the testicle. A short time after, from exposure to cold, 
perspiration became suppressed, and pain in the loins was experi- 
enced. This pain was probably situated in the secreting organs of 
the urine ; since, simultaneously, its emission became very frequent, 
the last drops were expelled with difficulty, and its composition was 
much altered. The inflammation then extended by means of the 
bladder from the urethra to the kidneys, in the same manner that it 
extended by the vasa deferentia to the testicles. 

The urine deposited an abundant gravelly sediment, and at the 
same time contained semen in suspension. The bladder had become 
more sensitive to the presence of urine, for the desire to empty it was 
often and very suddenly renewed. The seminal vesicles were exactly 
in the same condition, and the semen was passed without erection 
during sleep ; in addition to which, the contractions of the bladder 
necessary for the expulsion of the last drops of urine caused con- 
tractions in the seminal vesicles, and the fluid expelled was viscid and 
glairy. Both classes of symptoms ceased, re-appeared, and were 
cured at the same time ; and they were evidently due to a state of 
inflammation, for the antiphlogistic treatment was the only one that 
succeeded in removing them. 

The injurious effects of cold were very evident in the case of M. 

N , and may be attributed partly to his lymphatic temperament; 

but we often find analogous phenomena in patients of a very different 
constitution. However this may be, I am convinced that without the 

habitual use of flannel next his skin, M. N would not have been 

able to preserve himself from further relapses, or permanently to 
strengthen his constitution. 

M. N had undergone several courses of anti-venereal treat- 



SPERMATORRHEA. 65 

ment, although he had only suffered from blennorrhagia, and the ef- 
fects of mercury were very injurious to him, as his constitution was 
little fitted to withstand its action. He fell also into other very 
common errors, which are the ordinary result of an almost universal 
false reasoning on the part of the sick. Perceiving that he lost flesh, 
he eat heartily, and chose the most nutritious kinds of food : diges- 
tion being performed badly, and accompanied with the development 
of flatus, because the stomach shared the general weakness, he had 
recourse to rhubarb, generous wines, and spices. Hence frequently 
arise the attacks of chronic gastritis, which so constantly accompany 
old cases of spermatorrhoea. 

M. N 's intellectual functions were weak in common with the 

rest ; he was habitually drowsy, and he took coffee and tea to rouse 
himself. 

At length M. 1ST , like many other practitioners, began to treat 

symptoms, and allowed himself to be influenced by the names given 
to medicines : his urine was thick, deposited a sediment, and was 
passed with difficulty ; he took nitrate of potass as a diuretic, with- 
out reflecting that the increase of secretion which this medicine pro- 
duces, is the result of excitement of the urinary organs, and that 
his were already too much irritated. His bowels being constipated, 
he took purgatives without seeking the cause of constipation, and 
without troubling himself about the effect which irritation of the 
rectum produces on the blader, the prostate, and the seminal vesi- 
cles. These are errors of daily occurrence. 

The abuse of cold in cases of nocturnal and diurnal pollutions is 
very common. By bathing in the river M. N followed the ad- 
vice laid down by all writers on the subject: it proved injurious to 
him, however, because the genito-urinary mucous membranes were 
too irritable not to receive a hurtful shock from immersion in cold 
water. The patient should have foreseen this result from the bad 
effects cold had always produced on him ; besides this, he was too 
weak to obtain a proper degree of reaction after bathing. I shall 
show by and by that cold baths employed without distinction in cases 
of spermatorrhoea, have done much more harm than good.' Still the 
patient found that sea-bathing at a later period gave tone to his geni- 
tal organs, and he was unable to reconcile two effects of so opposite 
a nature ; yet nothing is more simple. When he took sea-baths he 
was cured; the irritation of the organs had passed off, and their 
normal condition had returned ; the first shock of the cold then was 
no longer injurious, and the consecutive reaction followed rapidly. 
It is true that considerable difference exists between sea and river 
bathing; but it is chiefly to the different states of the system that 
the two very opposite effects of cold on this patient must be referred. 

From not having attended to this important distinction, general 
directions have been given respecting the use of these powerful 
agents, — directions which daily lead to the most disastrous results. 
5 



6Q CAUSES OF 



CASE VI. 

Masturbation — Blennorrhagia — Diurnal pollutions — Failure of the ordi- 
nary modes of treatment — Cauterization of the prostatic portion of the 
urethra — Rapid recovery. 

Alexis Poit, set. 20, short, stout, and of a sanguineous constitution, ap- 
plied at the Hotel Dieu, Montpellier, to he cured of a venereal taint, which, 
he said, existed in his system, in consequence of an attack of blennorrhagia 
contracted three months previously, and cured in a few days by the simple 
use of dandelion tea. 

Nothing in the appearance of the patient confirmed this statement. He 
complained, however, of violent pain in his head, pain in his bones, frequent 
spasmodic tremors in his limbs, and a constant agitation which prevented his 
enjoying an instant's sleep; of stunning sensations and vertigo, with ringing 
in his ears; of a sense of suffocation with palpitation of the heart, and of 
itching in the skin: his eyes were injected, dry, and very sensitive to the 
impression of light. 

Out of all his symptoms, the ossific pain was the only one that could fa- 
vour the idea of a venereal taint; the patient said that he suffered most 
during the night, but his answers were very obscure and often contradictory. 
His skin, however, was hot and dry, and covered with pimples. I prescribed 
for him venesection, baths, and refrigerant drinks. 

The next and , following days, discharges occurred, and he seemed still 
more satisfied that he laboured under a syphilitic taint. His constitution 
seemed strong, and his appearance proclaimed health. I thought, there- 
fore, at first, that he had some motive for feigning various diseases, but as 
he did not eat, and seemed inclined to submit to moxas and other means of 
the same nature, I observed him more closely. The pupils looked on him 
as a hypochondriac or a maniac, because he complained of a fixed pain in 
the hypogastriuni, although his tongue was neither red nor dry; and be- 
cause he said he heard a continual noise in his belly, and felt a hand of iron 
pressing on his intestines for several hours together, and then relaxing them 
suddenly. 

When this oppression came on, he felt something ascending from the epi- 
gastrium that almost suffocated him, and ceased suddenly on his passing flatus. 
He was habitually costive, his faeces were very offensive. He passed water 
very often, and complained of pain in the penis and bladder during micturi- 
tion; this he attributed to the suppression of the blennorrhagic discharge. 
Twelve leeches were ordered to the anus ; with general baths, which relieved 
the pains in the bladder and penis. 

I advised the patient to get up and take exercise, but he pretended that 
his legs were unable to support him, and he spent all his time with his head 
under the bed-clothes, groaning and sighing. 

Having observed many of these symptoms in persons suffering from 
spermatorrhoea, I questioned Poit on this subject; but he had never noticed 
any discharge resembling semen, either while passing urine or faeces. He 
had never had intercourse with any female, except her from whom he had 
contracted blennorrhagia, and with her very rarely, and at very distant 
intervals. 

From the way he deplored the moment of folly to which he owed his suf- 



SPERM ATORRHCEA. 67 

ferings, I suspected that he had been addicted to masturbation : he denied 
it obstinately, however, before the pupils, but told me privately that he had 
practised it from the age of ten, even five or six times a day : at first he ex- 
perienced a very lively tickling sensation, accompanied by discharge, and 
soon changing into a painful sense of burning. About the age of twelve, 
having perceived that these injurious practices injured his health, he became 
more careful; but about fourteen, he again gave himself up to the vice almost 
madly. The irritation was now often carried so far as to produce pain; the 
veins of the spermatic cords swelled, and there existed in his whole body, 
especially in his loins and joints, a sense of debility, attended by obtuse pain. 
He had continual vertigo, with noise in his ears, and his memory became 
impaired. From sixteen to eighteen he restrained himself by degrees, and 
regained his strength and stoutness. At this time he first had sexual inter- 
course, soon after which blennorrhagia came on. 

I requested the patient to preserve his urine, and to notice carefully what 
passed from the penis when he was at stool. I found the urine red, thick, 
and muddy, with a flaky cloud suspended in it ; the sides of the vessel were 
lined by a brick-dust-like powder, and a glairy and tenacious sediment was 
adherent to. its bottom. The patient noticed that the last drops of urine were 
thick and viscid, and were passed with sudden and involuntary contractions 
of the bladder. After passing faeces he found a thick, granular, and trans- 
parent matter at the orifice of the urethra. 

I prescribed for him milk three times a day, taken as cold as possible, and 
mixed with Eau de Spa or lime water ; a vegetable diet ; two cold hip baths 
daily, each of a quarter of an hour's duration; and a cold enema night and 
morning, to facilitate the passage of the fseces. 

These means, which I had seen recommended by Wickman and Saint 
Marie, and which had succeeded in other cases, did not produce any im- 
provement in this. The patient became more restless and hypochondriacal, 
and did not sleep an hour during the night. Emollients and leeches relieved 
his pain, but at the same time relaxed his system; he suffered less, but he 
passed much more semen. Tonics and cold diminished for a time the semi- 
nal discharge, but they increased the pain and irritation. 

After about three weeks of these fruitless essays, I gave up general means 
altogether, and as I was convinced that the spermatorrhoea arose from a state 
of chronic inflammation of the prostatic mucous membrane, the irritation of 
which extended to the ejaculatory ducts and seminal vesicles, I considered 
that by removing this state of the membrane by means of cauterization, I 
should put an end to the irritation of the spermatic organs, and especially to 
the spasmodic contractions of the seminal vesicles. 

The beneficial effects which I had obtained from the use of nitrate of sil- 
ver in analogous cases of irritation, made me little dread the danger said to 
be attached to cauterization of the prostatic portion of the urethra, on account 
of its vicinity to the bladder. 

In order to empty the bladder, and to take the exact length of the urethra, 
I was obliged to introduce a catheter, which had scarcely entered an inch or 
two into the canal, when violent spasmodic contractions commenced, which 
prevented it from advancing, and almost made me suspect the existence of 
stricture; after a few seconds these spasms ceased, and the cathether passed 
as far as the neck of the bladder. Here the pain and spasms were redoubled, 
and the bladder seemed perfectly closed. At length, after a considerable" 
time, I was enabled to introduce the point of the catheter into the neck of 



6$ causes or 

the bladder, and the instrument was immediately powerfully drawn into the 

vesical cavity, as though by a kind of suction. TThen untouched, the ca- 
theter was several times suddenly attracted and repelled alternately, by the 
convulsive action of'the muscles of the perineum and bladder; and its ex- 
traction was almost as painful and difficult as its introduction had been, so 
firmly was it held by the neck of the bladder. The vesical contents were 
rapidly and forcibly discharged. 

All these circumstances confirmed me in the diagnosis I had formed re- 
specting the cause of the disease, and I immediately applied the solid nitrate 
of silver to the prostatic portion of the urethra. The application was rapid 
— lasting only long enough to incline the caustic to the right and left, so as 
to make it pass quickly over the inferior surface of the canal. 

During the first twenty-four hours, the patient suffered much while pass- 
ing urine. On the second day, the pain was much less severe, and on the 
third day. it was scarcely worth notice. During these three days, the urine 
was thick and muddy, and the last drops were streaked with blood. After 
this time it became transparent, and the patient was able to retain it much 
longer. 

Twelve days after the cauterization, the urine was quite normal, without 
either deposit or cloud — the last drops were expelled easily, and were as 
transparent as the first. The patient no longer experienced tension or un- 
easiness in the perineum, or involuntary contractions of the neck of the blad- 
der; but when his bowels were confined, he still noticed a viscid matter at 
the orifice of the urethra. 

The first improvement noticed was in his sleep, which became sounder 
and longer; then the moral and physical man became more energetic ; and 
lastly, the activity of the digestive organs returned. "Within fifteen days 
erections re-appeared, and after some time the patient experienced noctur- 
nal pollutions, preceded by erotic dreams, and accompanied with lively 
sensations. The intellectual powers were the last to be entirely re-estab- 
lished; but they did not appear to have ever been very active in this 
patient. 

At the expiration of a month, his health was quite perfect, and he wished 
to resume his former occupation. 

This patient was the first on whom I practised cauterization as a 
remedy for spermatorrhoea ; and I have related his case chiefly to 
show the active and painful contractions of the neck of the bladder 
and urethra which occur in such cases. These facts may give an 
idea of the extreme state of irritation of the urethral mucous lining, 
and of the influence which this condition must exercise over the 
seminal vesicles. 

The phenomena above described are very often observed in pa- 
tients affected by spermatorrhoea; their study is therefore important 
in deciding on its treatment — thus, for example, I have noticed that 
the greater the state of irritation the more certain are the effects 
of cauterization: in these cases, also, tonics, ice, and cold hip baths, 
are by no means proper. In the case I have just related sperma- 
torrhoea was, without doubt, caused by the blennorrhagia, but the 
excessive masturbation to which the patient had been addicted, even 



SPERMATORRHOEA. by 

before puberty, must have contributed much to produce this unfor- 
tunate disease, and, probably, from this circumstance it arose that a 
cure was impossible by the employment of the usual simple means. 

CASE VII. 

Abuse of spirituous liquors — Blennorrhagia — Nocturnal pollutions — Impo- 
tency — Frequent discharge of urine — Cauterization — Cure. 

J. D at an early age accustomed himself to an excess of alcoholic 

drinks, but in other respects, was remarkably abstemious: at the age of 
twenty he contracted blennorrhagia, which disappeared of its own accord 
at the end of about three weeks. A short time after he noticed that noc- 
turnal pollutions occurred very frequently, sometimes happening eight or 

ten nights consecutively. The day following these discharges D was 

depressed in spirits and suffered from headache, noise in the ears, and 
dazzling before the eyes: these symptoms induced him to submit to vene- 
section three times, and to apply leeches to the temples, after which D 

entirely lost all virile power- 
After the disappearance of the blennorrhagia a yellowish discharge from 
the anus came on several times, and was accompanied with a very trouble- 
some itching. Soon after this the patient had a tetter on the face, for which 
he took alteratives and mercurials. The skin disease disappeared, but symp- 
toms of irritation of the bladder supervened. 

In 1824, D , aged twenty-four, came to the hospital of St. Eloi, in 

the following state. He was of the middle height, and well made, his skin 
was pale, his hair black, his face very red, his manner gloomy and taciturn; 
he was fond of solitude, showed perfect indifference towards women, and 
great horror of masturbation. His intellect was dull, his digestion painful, 
and his limbs weak. He passed urine two or three times an hour during 
the day, and five or six times in the course of the night, attended by scald- 
ing and pain in the canal. 

The introduction of a silver catheter of moderate size excited spasmodic 
contraction and acute pain in the neck of the bladder, which induced me 
to propose cauterization to the patient: he agreed to it without hesitation, 
and I performed it immediately. 

I introduced the caustic holder into the bladder so as to cauterize the 
parts near its neck, and I passed the caustic over the prostatic surface as 
well as over the membranous portion of the urethra in withdrawing it. 
Immediately afterwards there was a pressing desire to micturate, and blood 
passed with the urine. Baths and barley water were ordered. 

During the following night he experienced a painful seminal emission; he 
passed urine only once, but with an acutely burning pain. 

On the following day the patient only passed urine four times, but always 
with burning and a slight discharge of blood. 

On the third day he no longer passed any blood, and the scalding was 
very slight. 

On the fourth day the emission of urine took place every three or four 
hours only, and the discharge arising from the cauterization had ceased. 

On the following days emptying the bladder was performed less aud less 
frequently; seminal discharge no longer followed j the patient regained his 



TO CAUSES OF 

spirits; Lis health became perfectly re-established, and about the fifteenth 
day after the cauterization he left the hospital. 

In this patient the blennorrhagia had not been preceded by exces- 
sive sexual intercourse or masturbation; but the abuse of alcoholic 
stimulants is almost as pernicious in its effects on the genito-urinary 
organs ; besides this he possessed a strumous habit, "which showed it- 
self by the tetter on the face and the abscess at the margin of the 
anus. It is especially in cases of this kind, that tonics, ice, and 
cold bathing fail, and are even injurious; happily, we possess a 
powerful remedy in cauterization. 

In this case the tetter on the face having disappeared, inflamma- 
tion of the vesical mucous membrane occurred; this was very in- 
tense, the patient passing urine two or three times in the hour; from 
this time the urinary symptoms predominated, on which account 
catheterism was accompanied with acute pain in the prostatic region, 
and spasmodic contractions of the neck of the bladder. 

Not long since cauterization of the prostatic portion of the urethra 
was looked on as the extreme of rashness, so much was the introduc- 
tion of the least particle of the nitrate of silver into the bladder dreaded; 
although these fears were only founded on argument, they were gene- 
rally received, and seemed so natural that I was influenced by them 
for several years. I have stated in another place the means by which 
I shook off these foolish fears, and the successful results that have 
followed the application of the nitrate of silver to the mucous mem- 
brane of the bladder in catarrhal affections of that organ. 1 Since 
that time, whenever I meet with cases in which the affection of the 
prostatic mucous membrane extends to that of the bladder, I begin 
by cauterizing the latter, and I continue the application as far as the 
bulb of the urethra whilst withdrawing the instrument, by inclining 
it rapidly to the right and left. It is not to take the length of the 
canal that I introduce a catheter in these cases, but in order to empty 
the bladder completely, so that the nitrate of silver may act with 
more energy. We have just seen the effect of this treatment: a 
patient who previously passed urine two or three times in the hour 
was enabled to retain the excretion as long as is usual, and at the 
same time the spermatorrhoea from which he suffered was cured. 

This case also confirms in a remarkable manner what I have above 
stated respecting the relations that exist between the diseases of the 
urinary, and those of the spermatic, organs. 

1 Vide Legoiis de Clinique, &c. 



SPERMATORRHEA. 71 



CASE vni. 

Masturbation — Blennorrhagia, repeated anti-venereal treatment — Diurnal 
pollutions — Increasing weakness, especially of the mental faculties — Ex- 
treme emaciation — Cauterization, and cure after sixteen years. Venereal 
excesses, relapse — Cauterization again performed with success. 

M. V , of spare habit and nervous temperament, was addicted to mas- 
turbation about the age of puberty, but abstained when he perceived his 
health affected. He again practised it as soon as his strength began to re- 
turn, and renounced it as soon as he perceived his health endangered. He 
again regained his strength, and applied himself with diligence and success 
to the study of law. 

At the age of eighteen he contracted blennorrhagia, which was treated 
during six months with injections of acetate of lead, sulphate of copper, &c. 
The discharge disappeared after a journey on horseback — again came on 
soon after, and again stopped. Urethral discharge was afterwards often ex- 
cited by very slight causes. 

Independently of tonics, injections, and astringents, which were prescribed 
for this patient without the least discretion, bichloride of mercury, mercurial 
pills, sarsaparilla, and friction with mercurial ointment, were recommended. 
His health became more and more disordered; he was subject to headache and 
pains in his limbs and loins, accompanied with debility, loss of sleep, and 
frequent attacks of fainting. 

M. V attributed all these symptoms to the presence of a venereal 

virus in his system, and as they increased several times after sexual inter- 
course, he was persuaded that he had on each occasion received fresh in- 
fection. At length the care of his health became quite a kind of monomania. 
He abandoned the career he had followed for eight years, and came to 
Montpellier to study medicine for the sole purpose of arriving at the cause 
of his complaint, and finding a remedy for it. Returning always to the 
idea of a syphilitic virus, he submitted himself successively to all the anti- 
syphilitic modes of treatment he could discover recommended by authors, 
and combined them together in various ways. 

Still, however, his strength diminished by degrees; his digestion became 
painful and laborious; and he was annoyed by flatus and obstinate consti- 
pation, which he combated by the frequent use of purgatives. His intel- 
lect became so far weakened that he could not fix his attention during a 
lecture, and soon even he became unable to comprehend what he read. 

He attended the courses of the faculty, but he was unable to remain 
during half a lecture without experiencing fatigue and impatience : his head 
became congested, and he felt a constant desire to change his position, or 
to walk. 

Though formerly competent to argue with pleasure on the most abstract 
propositions, he was now unable to follow the simplest reasoning; and the 
most recent, and important facts escaped his recollection. He was tor- 
mented by attacks of vertigo, loss of sight, and noise in the ears. The 
least intellectual excitement induced fits of heat in the head; and slight con- 
gestions were often excited by the digestive process, by flatulence, or by 
efforts at stool. 

The patient having his mind continually occupied by these symptoms at 



72 CAUSES OF 

length persuaded himself that part of his cerebral substance had been ab- 
sorbed, and that his cranium only contained the nerves of sense ; he thought 
he could feel these bathed in serum, and he was obstinately of opinion that 
he was threatened with an attack of apoplexy. 

On the other hand his character became sad, variable, and unsociable; 
he disliked music, of which he had previously been passionately fond; he 
slighted all his friends, and his misanthropy became so great that when he 
saw an acquaintance in the street he turned on his heel in order to avoid 
him. Tormented by a constant desire for motion, he was unable to remain 
long in the same place; and this restlessness, together with his love of soli- 
tude, made him wander constantly in all the by-ways of the neighbourhood 
of Montpellier. He was careless of every thing, and often in distress from 
having neglected his affairs. 

At length, after remaining seven years at Montpellier, M. V came 

to consult me. From the first words he said to me I suspected that he 
suffered from diurnal pollutions, and I questioned him closely on this head; 
but he had never noticed spermatic discharges either whilst passing urine 
or faeces, and he persisted in the opinion that his disorder arose from a vene- 
real virus still existing in his system. 

A short time afterwards, to relieve an attack of cerebral congestion, he 
applied leeches to the anus, and was unable to leave his bed for three 
months. 

The observations he made during this period convinced him that my dia- 
gnosis was correct, but he still wished to treat himself, and, among other 
means, placed pounded camphor between the glans penis and prepuce, in 
order to act directly on the genital organs : a few hours after, on going to 
stool, he passed a large quantity of semen, fainted, and remained some time 
before he was able to call assistance. 

I never witnessed a more repulsive sight than that I saw on reaching M. 
Y — 's residence; the disorder and dirt that surrounded him evinced the 
most perfect carelessness. Muddy urine, of a fetid smell, filled a dirty ves- 
sel placed near the head of his bed on a chair covered with dust and clothes. 
He was extremely pale, and greatly emaciated; he threw himself about on 
his bed like a person moribund, his limbs were cold, and his pulse weak and 
irregular. 

As soon as he was able to understand me, I proposed cauterization of 
the prostatic mucous membrane to him; he joyfully consented, and I per- 
formed it the same day. 

The moderate sized silver catheter, which I introduced first to empty the 
bladder, excited spasmodic contractions of the canal, and appeared to give 
considerable pain especially in the prostatic region — further confirming me 
in my opinion that the prostatic portion of the urethra had been a long time 
the seat of chronic inflammation. 

The application of the caustic presented nothing worthy of record. 

Two days after the operation, the patient experienced a feeling of vigour 
in the genital organs, and of general comfort which gave him hope. Soon 
after he regained his spirits, appetite and sleep returned; his voice acquired 
strength; he felt his taste for music return; he sought out his friends; his 
face entirely changed its expression, and his mirth became even boisterous. 

At the expiration of fifteen days from the operation he experienced vene- 
real desires, and erections were frequent and energetic. His appetite was 
good and his digestion acted with an unusual energy. 



SPERMATORRHEA. 73 

His health continued to progress favourably until, to hasten his restora- 
tion, he introduced a paste containing acetate of lead and copaiba into the 
urethra. After this the spermatic discharges reappeared, inflammation ex- 
tended to the testicles, and suppuration occurred in the left, notwithstanding 
active measures. An ounce of pus, which seemed to me to be discharged 
from the tunica vaginalis, followed a puncture on the left side; after the 
escape of this, all the disorders disappeared by degrees, and convalescence 
proceeded rapidly. Within a month, all M. V 's functions were per- 
formed with a regularity which he had not enjoyed for twenty years pre- 
viously. 

M. V possessed considerable natural talents, and related the sensations 

he had experienced, the opinions he had formed on his disease, and the mo- 
tives of his most extraordinary actions, in a very lively manner. 

Two months afterwards, however, M. V came to me as sad as ever. 

He informed me that, being tormented by frequent erections, he had more 
consulted his desires than his strength. This want of restraint had repro- 
duced in a fortnight all the irritation under which he had previously suffered, 
with the disorders following it. He had then broken off these habits, but 
his health had not become reestablished because diurnal spermatic discharges 
had reappeared. 

I performed a second cauterization similar to the first, and with an equally 

good result; and this time M. V , having gained experience, became 

more moderate in his conduct and returned to his residence. 

This case ought to be placed by the side of the first two I have 
related in which the post-mortem appearances are recorded. The 
symptoms were almost as severe, they presented the same characters, 
and gave rise to the same delusions as to the state of the brain. 

The rapid reestablishment of the intellectual functions in M. 

V proves that he had no greater cerebral disorganization than 

the other patients ; it seems probable, however, that in the first cases 
the alterations of the spermatic organs had proceeded further than 
in the case just related. 

The obstinacy with which M. V continued to treat an imagi- 
nary venereal affection is remarkable ; we have already seen an in- 
stance of it in the fifth case I have recorded. In neither case were 
there syphilitic symptoms, either primary or secondary. Such pre- 
convictions are very common in nervous patients, and their surgeons 
sometimes share them. The wandering, dull, and deep-seated sen- 
sations complained of are especially liable to be mistaken for the 
pain in the osseous system which follows syphilis. 

This case is well suited to show how difficult it is for patients to 
discover those seminal discharges which take place whilst emptying 

the bladder and rectum. M. V had only one wish — to discover 

the origin of his disorder. To this desire he sacrificed every con- 
sideration, and for this end he came to Montpellier to study medi- 
cine : he was not far from the truth, for he thought constantly of the 
blennorrhagia which had preceded the disease, yet after fifteen years 
of daily observation and seven years of application to medical studies 
he had not even suspected the existence of involuntary spermatic 
discharges. 




<4 CAUSES OF 

Let us judge by this how many hypochondriacs owe their torments 
to the same cause. 



CASE IX. 

Blennorrhagia, followed by excoriations of the glans penis — Spermatorrhoea 
— Cauterization unsuccessful — Artificial sulphur baths — Cure. 

M. B , Lieutenant of Light Cavalry, affected with varicocele, contracted 

blennorrhagia in 1818. Emollient drinks and warm baths reduced this 
attack at the end of a month to a slight discharge, which soon after entirely 
ceased; excoriations had, however, previously appeared around the orifice of 
the glans penis. These excoriations healed in about twenty days, under the 
use of cold lotions : they reappeared four months after, and were cured by 
the same means ; they afterwards showed themselves periodically every three 
or four months, and were not in any way affected by anti-venereal treatment 
of a very active kind, which the patient submitted to. Each time their ap- 
pearance was preceded by pain in the perineum and testicles, increased by 
the passage of faeces. 

After the expiration of five years, the excoriations ceased, and the pain, 
which had previously been relieved by their appearance, became permanent, 
and was accompanied by discharge of semen during defecation. The patient 
suffered pain in the region of the kidneys, which became insupportable after 
remaining under arms for a few minutes; his urine deposited a whitish sedi- 
ment. 

Sea bathing increased the pain in the perineum, and the difficulty of passing 
urine : fresh water bathing increased the pain in the loins : his digestion was 
disordered. 

When M. B came to ask my advice, I at first suspected that a stric- 
ture existed, and endeavoured several times to examine the urethra with a soft 
wax bougie; each time, however, the instrument was arrested in a different 
situation, and when withdrawn, presented a different form. After a few days' 
rest, I introduced an ordinary catheter into the bladder, without meeting with 
any permanent obstruction, but with severe pain to the patient, especially in 
passing the bulb of the urethra. There was, then, in this patient, only a state 
of extreme irritability of the urethral mucous membrane. I hoped to cure 
this by means of cauterization with the nitrate of silver, as I had done before; 
but, on this occasion, no effect was produced. 

Recollecting, then, that the disappearance of the excoriations on the glans 
penis had been followed by an increase of the disease, I prescribed artificial 
sulphur baths, containing two ounces of sulphuret of potassium in each. At 
first, the baths produced an excellent effect, but afterwards, a severe irritation 
of the stomach, and the return of all the symptoms were occasioned. I dis- 
covered, however, that sulphuric acid had been added to the last baths : this 
was omitted, and as soon as the patient resumed the use of the baths con- 
taining sulphuret of potassium only, his state improved rapidly. 

At the expiration of a month, his pain had disappeared, his urine was 
transparent, and the passage of faeces was no longer accompanied by seminal 

discharge; digestion became active, and M. B soon regained his strength 

and stoutness. 



SPERMATORRHOEA. 75 

M. B , previously to the attack of blennorrhagia, had never 

suffered from any cutaneous affection ; from this date ulceration ap- 
peared periodically round the glans penis : this might be supposed to 
have arisen from a syphilitic affection, but it resisted the most active 
anti-venereal treatment. Its appearance put an end to the pain in 
the perineum and testicles: as soon as the sores healed, these symp- 
toms returned, and diurnal spermatic discharges accompanied them. 

It seemed probable that the application of nitrate of silver would 
lessen the morbid irritability of the urethral mucous membrane ; it 
produced no appreciable effect, however. 

Artificial sulphur baths were used with advantage when they con- 
tained only sulphuret of potassium ; when sulphuric acid was added, 
in order to increase their activity, all the symptoms re-appeared ; 
on resuming the use of the sulphuret of potassium alone, the cure 
proceeded with rapidity. 

It is remarkable, also, in this case, that river bathing always in- 
creased the pain in the loins, while sea bathing aggravated the pain 
in the perineum. Anomalies of this kind abound in the treatment 
of spermatorrhoea, and much careful research is often necessary to 
explain them ; the relation of such cases will, however, put practi- 
tioners on their guard by furnishing analogies for their guidance. 

Baths containing sulphuret of potassium are especially indicated 
whenever a cutaneous affection co-exists with considerable sensibi- 
lity of the, mucous surfaces; but, when the irritation of the genital 
organs is very severe, they are often contra-indicated. In such 
cases, cauterization, though it may not cure, at least will diminish 
the excessive sensibility. 1 

Causes. — I have before stated that the cause of spermatorrhoea 
is a most important circumstance for our consideration. The truth 
of this becomes more evident as we proceed ; but it often happens 
that several causes act simultaneously or successively, and that we 
are not able clearly to discover which of them exercises the greatest 
influence in the production of the disease. 

Blennorrhagia is the most active and the most direct, as well as 
the most easily appreciated, of all these causes, and this is why I 
have commenced by reporting cases in which it has played a princi- 
pal part. When these cases are examined separately with some 
attention, we soon perceive that the discharge has been preceded, 
accompanied, or followed, by some circumstances capable, by their 
own action, of giving rise to spermatorrhoea. It is necessary to pay 
attention to this point. 

In one patient I had occasion to treat, hereditary pre-disposition 



1 M. Lallemand has reported many more cases of involuntary spermatic discharges 
following blennorrhagia; as, however, they differ very slightly from one another, 
and the same treatment was applied to all, I have thought it as well to omit the re- 
mainder of them. In fact the connexion between blennorrhagia and involuntary sper- 
matic discharges, seems so well established by the cases above related, as to require 
no further confirmation.— [H. J. McD.] 



76 CAUSES OF 

probably existed, for his father had been also affected by spermator- 
rhoea ; others had a very marked lymphatic temperament, as in the 
fifth case I have reported. Many were naturally weak, delicate, 
and nervous ; or their health had been injured by bad habits, or a 
too sedentary life ; others, again, suffered from tetters, hemorrhoids, 
or varicocele. 

By far the greater number of the patients who have come under 
my care, had committed excesses, either in coitus, masturbation, or 
the use of alcoholic stimulants. 

Blennorrhagia in many cases is neglected ; patients are too timid 
to mention it, or too careless, and too much occupied to pay atten- 
tion to it ; in other cases, the treatment is rendered useless by im- 
prudence or excess ; but, in many cases the inflammation produces 
injurious effects by its simple presence for a short time. 

Many of my patients had had two attacks of blennorrhagia, and in 
one case as many as seven were experienced, before spermatorrhoea 
commenced; but, I must remark, that in these cases, the recurrence 
of the discharge is not always due to a fresh infection, as the pa- 
tients and many surgeons believe ; the facility with which blennor- 
rhagia often recurs without coitus, is sufficient evidence that it may 
return spontaneously, or, at all events, from very slight excitement. 
This disposition to a recurrence of the discharge may be easily un- 
derstood, if the increased development of the capillary system in the 
mucous follicles after repeated or continued attacks of inflammation 
be taken into consideration. 

These patients almost always in the end suffer from spermator- 
rhoea. In fact it is difficult to avoid, sooner or later, an extension 
of the inflammation of the prostatic mucous follicles to the sperma- 
tic ducts. We must not, however, mistake for semen, the mucus 
which constantly moistens the urethral orifice in such persons ; and, 
on the other hand, we must be careful to guard against repelling too 
lightly their apprehensions on this account, because chronic catarrh 
of the urethra often accompanies spermatic discharges, and is a sign 
of their presence by no means to be disregarded. 

In some of the cases I have seen, involuntary spermatic discharges 
seem to have been kept up by a venereal taint, and such have been 
relieved by anti-venereal treatment; on the other hand, in some 
cases, the seminal discharges have not seemed to be influenced 
either by the venereal affection, or the means employed for its cure. 

Anti-venereal treatment is frequently also employed in patients 
who have suffered merely from blennorrhagia, and in a very nume- 
rous class of cases it produces a serious increase of the irritation in 
the genital organs, and causes the appearance, or exasperates the 
effects, of involuntary spermatic discharges. 

Cases of this nature often present considerable difficulties of diag- 
nosis ; and the solution of these obscurities is always of much im- 
portance in determining the treatment to be followed. 

Anti-venereals are not the only therapeutic agents which produce 



SPERMATORRHEA. 77 

such unfortunate effects; those which a blind routine of practice em- 
ploys in cases of blennorrhagia have not been less injurious ; among 
these it is especially necessary for me to mention astringent injections, 
copaiba, cubebs, tonics, and bitters employed too soon, or in extreme 
doses. All these means act more or less by exciting the genito-uri- 
nary organs ; it is therefore easy to understand that their untimely 
or immoderate use must favour an extension of the inflammation from 
the urethra to the mucous membranes which are continuous with it. 

I am far, however, from wishing to proscribe the use of these re- 
medies, and I willingly bear testimony to their beneficial effects, 
after the inflammatory symptoms have been subdued. A time ar- 
rives when the mucous membrane of the urethra, like all other 
membranes of the same class, requires the employment of tonics 
and astringents; but in the way they are daily prescribed, , I am 
convinced more harm than good results from their use. 

Lastly, spermatorrhoea is often made worse by the very means 
employed for its removal, and among these may be ranked cold 
baths, ice, tonics, bitters, sulphur-baths, &c. 

In all the cases I have so far considered, blennorrhagia has exer- 
cised the chief influence in inducing spermatorrhoea; it is, however, 
rarely sufficient singly to bring on this fatal disease, and the causes, 
which in the cases I have related have been accessory only, may ex- 
cite, each by its own action, more or less serious involuntary seminal 
discharges. These accessory causes exercise too great an influence 
to be passed over in silence : they are numerous and various, and 
succeed or are combined with one another in different ways — two 
cases seldom occurring which resemble each other exactly. 

The further we advance the more plainly we shall see how neces- 
sary it is for the different forms of spermatorrhoea to be described as 
simple affections — how necessary it is to regard them in all their 
aspects, and to take account of all the circumstances which assist in 
producing them. In practice we find it indispensable to weigh well 
all the points connected with a case of spermatorrhoea, before de- 
ciding on our diagnosis, prognosis, or, especially, on our treatment. 

Mode of Action. — In all the cases I have related the urethra 
retained an excessive irritability, especially in the prostatic region ; 
the patients felt constant pain, weight, heat, darting or painful tick- 
ling in this situation ; and these sensations were increased by the 
passage of urine. 

Catheterism, though performed carefully, always produced acute 
pain and spasm, sometimes sufficiently violent to simulate stricture. 
The catheter was especially arrested at the neck of the bladder, and 
often it could only be passed on after waiting a considerable time. 
The patients felt as if the instrument had passed over spots of ulce- 
ration. They were convulsively agitated, and all the power of a 
determined will was often insufficient to restrain their expressions of 
agony. Their faces were distorted, and their whole bodies covered 
by a profuse sweat. As soon as the catheter was withdrawn a con- 
siderable quantity of florid blood was, in most cases, discharged. 



78 CAUSES OF 






These different phenomena, which occur with more or less severity 
in every case, sufficiently indicate that the mucous membrane of the 
urethra possesses an extreme irritability, especially in the prostatic 
region. Several of the symptoms are even sufficient to make one 
suppose that it is granular, and very vascular or excoriated. A few 
of the patients I have treated experienced symptoms indicating still 
more positively an affection of the prostate, such as swelling of the 
organ, sense of weight in the rectum and perineum, darting pains in 
the neck of the bladder behind the pubes, &c, and, in one case, the 
inflammation of the prostate ended in suppuration. In many cases 
the testicles were swollen, inflamed, and painful (as in the fifth and 
ninth cases.) The spermatic cords also shared the condition of the 
testicles as in these cases. Lastly, in some patients who have con- 
sulted me, the seminal emissions contained blood or pus. 

Thus, in all such cases the blennorrhagia leaves great irritation 
and morbid sensibility in the urethral mucous membrane, most se- 
vere in the neighbourhood of the prostate, the principal seat of the 
primary disease. In many cases the inflammation extends its influ- 
ence to the testicles by means of their excretory ducts, and this 
should make us suspect that the spermatic organs may retain the 
same irritability as the urethra. 

The same phenomena are manifested in the urinary organs ; indeed, 
their resemblance to the spermatic is remarkable in more respects 
than one. 

Many of my patients had experienced acute inflammation of the 
bladder, (as in the seventh case.) Others had suffered from symp- 
toms of chronic inflammation of that organ. In a few, the inflam- 
mation seemed even to extend to the kidneys, if we may judge from 
the pain, spasm, and dragging felt in the loins, and the changes ob- 
served in the urine. 

These are the only circumstances which enable us to appreciate 
the state of the kidneys — organs out of reach of physical examina- 
tion ; but analogy confirms the results deducible from them. After 
having unequivocally proved the presence of orchitis, under similar 
circumstances we may well suspect the presence of nephritis, espe- 
cially when we observe symptoms which are otherwise inexplicable. 
Post mortem inspections have shown, in many cases, that these 
analogies do not deceive us, and I have found in the kidneys varied 
and serious alterations of structure which could only have been pro- 
duced by inflammation. 

All such patients, without exception, pass more urine during the 
twenty-four hours than natural : so that, although the kidneys may 
not be actually inflamed, it is evident that they are in a state of more 
or less active irritation, or, at least, of sufficient excitement conside- 
rably to increase their action. The same condition obtains in the tes- 
ticles, for although they may not be the seat of either inflammation 
or pain, their activity is increased. The semen is not only expelled 
involuntarily, but it is also secreted in greater abundance than na- 



SPERMATORRHOEA. 79 

tural ; for unless the secretion were increased, the seminal emissions 
would not be so frequent, and the weakening and exhaustion would 
not proceed so rapidly. 

The urine is not only more abundant but its nature is also changed, 
even after the pus and mucus contained in it have been removed. 
It is paler and more watery, and contains less urea and uric acid 
than natural. 

The semen also loses its peculiar odour, its colour, and its consis- 
tence ; it is, in fact, less perfectly formed than it ought to be. 

Lastly, all these patients experience a frequent desire to micturate, 
depending on the irritation of the bladder. Some are unable to hold 
their urine more than half an hour or an hour, (case seventh.) In 
all, the desire of micturition comes on suddenly and imperiously ; 
the spasmodic contractions of the bladder overcome all the efforts of 
the will, and the emission takes place suddenly and convulsively. 

This phenomenon gives us an exact view of what passes in the 
vesiculae seminales during involuntary seminal discharge; some 
patients even feel distinctly the contractions which announce an emis- 
sion as inevitable; others have not sufficient practical knowledge to 
recognise them, but their statements show that the same phenomena 
are experienced, even when analogy would not lead us to admit their 
presence. The analogy is, however, very evident, for it is especially 
during the expulsion of the last drops of urine that the spermatic dis- 
charge takes place, and the two classes of symptoms are in general 
relieved or exasperated at the same time and by the influence of the 
same causes. This remarkable resemblance may be explained very 
simply by referring to the fact, that blennorrhagia has its principal 
seat in the prostate, where the spermatic and urinary apparatus meet, 
and the connexion of the two classes of phenomena enables us still 
better to understand the causes and mechanism of spermatorrhoea. 

Treatment. — It is by no means astonishing that in this state the 
application of the nitrate of silver to the prostatic mucous membrane 
should produce effects more direct and powerful than those of any 
other remedy. We know well how promptly and effectually nitrate 
of silver acts on tissues which are granular, injected or swollen from 
the effects of prolonged inflammation. Its results are especially evi- 
dent in the chronic ophthalmia of scrofulous patients. Soon after 
the nitrate has been applied, the tissues empty themselves, contract 
and become paler, and they retain an energetic action which pre- 
serves them from a relapse, to which the patients are often liable 
when a cure has been obtained by other means. On this account I 
have employed nitrate of silver in the chronic inflammation of the 
vagina and neck of the uterus, which keeps up leucorrhoeal discharge 
in so many cases, and in chronic catarrh of the bladder, which is so 
difficult of cure by other means ; and I have always had cause to be 
pleased with its action in these affections. The nitrate produces the 
same effects on the mucous membrane of the prostatic portion of the 
urethra ; the organization and sensibility of the membrane are con- 



80 CAUSES OF SPERMATORRHEA. 

siderably altered, and this change is soon felt by the organs which 
are immediately influenced by its condition. 

Hitherto relaxation of the ejaculatory ducts has been alone thought 
of in cases of spermatorrhoea, and this exclusive idea has been a 
cause of much malapraxis ; but to attribute all cases of spermatorrhoea 
to irritation of the spermatic organs only, would be quite as erroneous 
and injurious. One patient I had occasion to treat was cured by 
tonics, another by antiphlogistics (case fifth ;) and I shall have to re- 
cord other cases of the same nature, but they are very rare. There 
exist almost always at the same time irritability and debility, extreme 
sensibility, and loss of tone in the spermatic organs. This state, 
however, we observe in the chronic affections of all mucous mem- 
branes ; indeed, we may even say, as a general rule, that the weaker 
the organs or individuals, the more easily are they excited. 

By acting on the surface of the engorged tissue, its morbid suscep- 
tibility is changed, and a contraction is afterward excited in it, which 
gives it energy. This is why one application of nitrate of silver ge- 
nerally suffices to produce a perfect cure. 

But when the disease has existed a long time the genital organs 
share the general debility of the system, and after the chronic inflam- 
mation has disappeared, it becomes necessary to aid the relaxed 
tissues to resume their former energy; nothing now contra-indicates 
the exhibition of tonics of all kinds, which complete the cure com- 
menced by cauterization. This explains how cold and sulphur baths, 
ice, &c, are useful after cauterization to individuals who were injured 
by them at first, (case ninth.) 

Symptoms. — Whilst examining the mode of action of blennorrhagia 
in producing spermatorrhoea, I have already referred to the symptoms 
which occurred in the cases reported; in the other cases I have seen, 
the symptoms have been common to all kinds of spermatorrhoea, and 
I cannot notice them here without being exposed, by and by, to use- 
less repetitions. I shall, therefore, only call attention at present to 
the insidious character of the general symptoms produced by these 
discharges, which often simulate the characteristic marks of cerebral 
affections, gastritis, diseases of the heart, urinary calculus, &c. 

The real cause of the symptoms is very difficult of detection in 
cases of spermatorrhoea; some of my patients had studied medicine 
for many years, in the sole hope of discovering it (case eighth;) we 
may judge from this how frequently cases of spermatorrhoea are mis- 
taken for other affections. 



( 81 ) 



CHAPTER IV. 

CAUSES OF SPERMATORRHEA. 

Cutaneous Affections. 

The following case is that of a student of medicine who came 
under my care. At my request he put it into its present form for 
publication. 

CASE X. 

Itch during ten months at about the age of fourteen — Pain in the epigastrium 
— Tumour of the testicle — Chronic inflammation of the bladder — Diurnal 
spermatic discharges — Hypochondriasis — Cure by Cauterization at the age 
of twenty-eight. 

"Up to the age of fourteen my health was very good, but at this period 
I was afflicted with psora, which continued for ten months in spite of various 
modes of treatment. Scarcely was this cured than I felt a sharp cutting 
pain in the epigastrium, after a time becoming dull and extended. The 
itching I had before felt over the whole body seemed to affect my head, and 
when I had been exposed to cold or damp, or had kept my head uncovered, 
the scalp became covered with little pimples, which, when scratched, formed 
scabs. 

"An induration of the left testicle of about the size and shape of a bean 
appeared, and continued during eight months. My digestion became de- 
ranged; my complexion darkened, and my shoulders became round; the 
epigastric region was so tender that I could not bear the weight of the bed- 
clothes, and when erect I seemed to have a weight suspended within me. 
At this time I was at school, but during the vacation I took an opportunity 
of consulting my family surgeon; he attributed all I felt to too rapid growth. 
Not being satisfied with this explanation, I consulted a bone setter well 
known in the neighbourhood, who said my breast bone was dislocated, pre- 
tended to replace it, applied a plaster, and sent me away as I came. 

"This state of things continued till I was eighteen, when I experienced a 
slight pain in making water, and became very costive. The epigastric pain 
diminished, however, and I gained flesh. 

"At the age of twenty-two, after domestic trouble, and perhaps, also, from 
the effects of some slight excesses, I experienced the following symptoms : — 
Progressive emaciation; lassitude after the least exertion; yellow, dry, 
and earthy skin; burning heat, especially in the palms of the hands and 
the soles of the feet; creeping sensation over all the body when I began to 
perspire; habitual sensation of internal heat; constant pain in the epigas- 
trium and right hypochondrium ; obstinate constipation; difficult diges- 
tion attended with the secretion of flatus; acid eructations, smellinsr 
6 



82 CAUSES OF SPERMATORRHOEA 






of putrid eggs; sometimes cold and clammy sweats, especially when 
I had taken any acrid or acid substance, or when I experienced the 
slightest contradiction, for I had become very irritable; impossibility of 
enduring hunger; difficulty of holding my urine, with pain at the base of 
the glans penis, and spasm at the neck of the bladder during its emission; 
the urine presenting, when cold, a red muddy -appearance, with an abundant 
brick dust sediment, and a cloud of flocculent matter in suspension; vene- 
real desires, with entire loss of the power of coitus; a discharge of a 
transparent and viscid matter after the least erection; an abundant discharge 
of a white, serous, slightly opaque matter from the urethra on going to 
stool; scurf and itching of the head; noise in the ears; loss of memory; 
feeling of discontent with myself; extreme timidity; dislike to all amuse- 
ments save solitary walks; deep melancholy without cause; loss of courage; 
sadness of countenance; all these symptoms were aggravated after horse 
exercise. 

"I consulted various practitioners, all of whom considered my state as ner- 
vous, and told me I was hypochondriacal; some, however, recommended 
emollients, baths, a vegetable and milk diet with exercise and amusement ; 
others prescribed bitters, tonics, alteratives, preparations of sulphur externally 
and internally, an issue, &c. All these modes of treatment were useless, or 
rather they increased my disorders, and in my painful condition I tried to 
contract a new itch, without success. 

" I now, at the age of twenty-eight, came to consult you The 

introduction of a catheter gave me violent pain, and caused spasm of the 
urethra, especially near the bladder. The application of the nitrate of 
silver dispersed the chronic inflammation which kept up the involuntary 
discharge of semen, and eight days after the cauterization I felt stronger, 
my limbs seemed more free, my urine became clear, and I began to hold it 
longer; my countenance appeared gay, and my complexion became fair. I 
had a nocturnal emission, a thing I had not experienced for a long time. 
At the expiration of three weeks I found myself in a perfectly new state ; 
during a period of ten years I had never felt so well. The cerebral functions 
and those of the stomach, intestines, bladder, and genital organs were per- 
formed with an unaccustomed energy ; my skin had lost its yellow and earthy 
appearance. The internal burning and the cutaneous tingling were removed. 
Nocturnal emissions, however, have since become very frequent, and from 
the fourth to this day, the twelfth of July, I have had four; nevertheless my 
strength has continued to increase daily, and I hope that a second cauteriza- 
tion will remove altogether a disease which all previous treatment had only 
served to increase." 

I cannot now say whether I yielded to this patient's desire for a 
second application of the nitrate of silver, but I certainly did not 
share his uneasiness respecting the nocturnal emissions. When these 
follow involuntary diurnal discharges of semen they show a considera- 
ble improvement in the state of the genital organs ; they prove, in 
fact, that the semen is no longer expelled as before in an almost con- 
tinuous manner. Indeed the patient experienced from this moment 
a rapid amelioration in all his functions, and an increase of strength 
which would be inexplicable under other circumstances. The desire 
for a fresh cauterization was not alone due to the fear of nocturnal 



CUTANEOUS AFFECTIONS. 83 

emissions ; it arose partly from a kind of blind faith in a remedy 
which had produced such prompt and satisfactory results. 

The desire for a second application of the nitrate of silver is felt 
by many of the patients who have once experienced its effects, and 
I have often been obliged to resist it. We must only return to this 
remedy when much remains to he effected, and when all improvement 
has been arrested for some time; so long as progress is made, how- 
ever slow it may be, there is reason for hoping that regimen, exer- 
cise, and a moderate use of the organs, will be sufficient to confirm 
the convalescence. 

The rapid cure of the hypochondriasis, treated for so long a time, 
and with such little success, by so many different means, sufficiently 
testifies that it originated in* the involuntary loss of semen. But to 
what cause can we attribute the spermatorrhoea? After the disap- 
pearance of the cutaneous affection, symptoms of chronic inflamma- 
tion of the stomach, and afterwards of the bladder, appeared. Then 
a tumour arose in the left testicle. The connexion between irritation 
of the skin and that of the mucous membranes is well known, and I 
have shown the manner in which affections of the urethra extend to 
the testicles. It is then easy to understand the course by which 
irritation extended to the spermatic organs, and excited spasmodic 
contractions of the seminal vesicles. 

The pain which the patient experienced in the neck of the bladder 
proves, also, that the involuntary discharge was really kept up by 
chronic inflammation in that situation ; the frequent desire of mictu- 
rition and the state of the urine, together with the sensation pro- 
duced by catheterism, and especially the rapid cure effected by the 
nitrate of silver, are further evidences in support of this opinion. 

CASE XI. 

Cutaneous affections — Repeated attacks of urethritis — Application of nitrate 
of silver — Cure. 

M. N , of an irritable constitution and subject to frequent and varied 

cutaneous eruptions from his infancy, suffered during youth from several 
slight attacks of urethritis, which always passed off rapidly; at the age of 
twenty-one he married. Still, however, the discharges reappeared several 
times with various degrees of duration and intensity, alternating sometimes 
with tetters and at others with boils. The urethritis supervened once on 
an eruption of pimples on the head which had lasted very long and left 
cicatrices similar to those of small pox. At other times unyielding attacks 
of ophthalmia and violent rheumatic pains came on during the absence of 
the cutaneous affection. Several times slight excoriations became irritated 
in a remarkable manner, and a simple scratch on the leg kept the patient 
in bed for several months. In 1820 on an attack of numerous and large 
furuncles, a more intense and painful urethritis than usual supervened. I 

found M. N in an extreme state of prostration and agitation, excited 

by harassing suspicions as to the nature of this discharge, which was 



84 CAUSES OP SPERMATORRHOEA. 

abundant and greenish and resembled in all respects that of an intense blen- 
norrhagia. As I knew my patient's constitution, I thought that the dis- 
charge depended on the general cause which had excited the former attacks, 
and therefore prescribed antiphlogistics and derivatives, to which it yielded. 

I afterwards advised emollients and alterative drinks, and still later the 

use of the warm sulphuretted springs : M. N went successively to Cau- 

terets, Luchon, and Aries, near Perpignan. 

At the expiration of three years his general health was improved, but the 
attacks of urethritis reappeared from time to time, especially in winter, when 
irritation no longer existed in the skin or any other organ; and he desired 
much to rid himself of these periodic discharges which embittered his exist- 
ence. I had previously successfully used the nitrate of silver in substance in 
several cases of inveterate blennorrhagia, and I proposed its use to him with 
the hope of considerably modifying the action of the urethral mucous surface. 
He submitted to it with eagerness, and the results surpassed my most sanguine 
expectations. 

Twelve years afterwards, M. N had not perceived the least trace of 

his distressing discharges, although he had travelled much, and had not 
restricted himself to any regimen or privation. But he soon perceived 
much more important changes. His venereal desires became more active 
and more imperious, his erections took on a new energy, and ejaculation 
no longer took place so precipitately as before; in fact he found himself 
at the age of fifty-five more vigorous, in all respects, than he had been at 
twenty. 

This single cauterization produced then a perfect revolution in 

the state of M. N 's genital organs, and its effects remained 

even after the expiration of twelve years. 

To obtain a correct idea of the importance of the change which 
had taken place in the urethral mucous membrane it is necessary to 

remark, that M. N remained subject to the same cutaneous 

eruptions, and that they alternated as before with ophthalmia, at- 
tacks of gout, wandering pains in the breast, abdomen, &c, but that 
from this time the urethra was never the seat of the inflammation, 
which still continued to attack the other organs. Thus, although 
the first cause continued to act on the other organs, the part cau- 
terized, remained, after twelve years, free from its influence. 

On the other hand, if we may be allowed to judge by analogy with 
the preceding cases, and by the general symptoms which accom- 
panied the repeated attacks of urethritis, they must have produced 
spermatorrhoea, although the patient himself did not suspect it. This 
is the only way in which we can explain the increase of energy in 
the genital organs notwithstanding the effects of age, and the in- 
creased vigour of the whole economy in spite of more frequent sexual 
intercourse. 

In fact, then, the nitrate of silver not only put an end to the dis- 
position to urethritis, but also destroyed a powerful and continually- 
debilitating discharge, which was undermining the patient's consti- 
tution, without his being able to discover the cause of his weakness. 



CUTANEOUS AFFECTIONS. 85 

CASE XII. 

Pruriginous eruption around the genital organs — Two attacks of blennor- 
rhagia — Nocturnal and diurnal emissions — Cure by means of sulphu- 
retted baths. 

M. L , at the beginning of the year 1824, was attacked by a prurigi- 

nous eruption on the scrotum, which extended rapidly and covered the geni- 
tal organs. After the least irregularity of diet, the surface of the scrotum 
assumed an inflamed appearance, and secreted a fetid discharge accompanied 
with violent itching. Baths, lotions of milk, decoctions of various kinds, 
and sulphur ointment, only gave temporary relief. 

In the month of June, 1824, four months after the first appearance of 

the eruption, M. L contracted a urethral discharge; the inflammation 

accompanying this was very slight, and the patient subdued it by baths and 
emollients. He attempted to take balsam of copaiba, but was soon obliged 
to leave off its use on account of the irritation it produced in the digestive 
organs. The urethral discharge diminished rapidly, but did not entirely 
disappear, a slight oozing of a viscid pearly matter remaining, which formed, 
at the orifice of the glans, a little* crust which the patient was obliged to 
remove in order to give passage to his urine. This discharge he neglected, 
and shortly after he noticed that semen was passed in large quantity during 
defecation. In the month of January, 1825, he contracted a second ure- 
thritis, which was more severe than the first. Acute pain was present in 
the fossa navicularis, and after a time in the region of the prostate. In a 
few days the inflammation was accompanied by general fever. The patient 
was then submitted to a rigid antiphlogistic treatment, and at the expiration 
of a week the local and general symptoms were much relieved; shortly after 
the discharge ceased entirely. 

In the month of February, M. L rubbed in mercurial ointment in 

order to prevent a venereal contagion. This inunction entirely removed 
the cutaneous disease of the scrotum, but a few days afterwards the old 
discharge reappeared, accompanied with itching of the anus, and contrac- 
tion of the sphincter ani ; feeling of arterial pulsation in the lower part of 
the rectum, especially after meals, when sitting, or during defecation ; ob- 
stinate constipation ; urine depositing a quantity of whitish flocculi, which 
formed on cooling an abundant cloud suspended in the middle of the fluid ; 
constant oozing of a fluid resembling semen, which formed a crust at the 
orifice of the urethra ; abundant seminal emissions during defecation ; noc- 
turnal emissions accompanied by pain of short duration, but sufficiently 
acute to arouse the patient from a deep sleep ; extreme sensibility of the 
canal on the introduction of a catheter, with acute pain in the prostatic re- 
gion ; the retina very sensitive to the effects of light ; noise in the right ear, 
worse at night than in the morning, and diflicult digestion accompanied by 
abundant discharge of flatus. 

I ordered for this patient twenty-four sulphuretted baths, containing, at 
first, one ounce, then one ounce and a-half, and afterwards two ounces of 
sulphuret of potassium. These means alone sufficed to perform a perfect 
cure at the expiration of two months. 

It is possible that both attacks of blennorrhagia in this patient were 
contracted in the ordinary manner, by contact with blennorrhagic 



86 CAUSES OF SPERMATORRHOEA, 






virus; but at the same time this does not seem probable, because the 
suppression of the skin disease on the scrotum was followed by a re- 
turn of the discharge. The mucous membranes, too, seem to have 
possessed an extraordinary sensibility, since the balsam of copaiba, 
given in the usual dose, induced great irritability of the digestive 
organs after a few days' administration. It is remarkable, too, that 
the cessation of the discharge followed the omission of the remedy. 
This susceptibility of the mucous membranes is very common in 
cutaneous affections, and explains the frequency of non-contagious 
attacks of urethritis in patients who suffer from them. 

The disappearance of the disease in the skin of the scrotum was 
followed by the return of the nocturnal and diurnal pollutions, but 
this time the irritation was more severe than ever, and was not con- 
fined to the mucous membrane of the genito-urinary organs ; it ex- 
tended also to that of the rectum, and the patient experienced itch- 
ing of the anus, spasm of the sphincter, and a feeling of pulsation 
in the lower part of the intestine. 

This coincidence confirmed me still more firmly in the opinion that 
the previous urethral discharge had not been owing to blennorrhagic 
contagion, and led me to order sulphuretted baths ; cauterization of 
the urethra would have produced no effect on the irritation of the 
rectum, and the latter would, alone, probably have sufficed to repro- 
duce involuntary spermatic discharges. The patient's rapid and 
perfect cure shows that the indication followed was the correct one. 

CASE XIII. 

Herpes prseputialis, alternating in a .remarkable manner with irritation in 
the prostatic portion of the urethra — -Nocturnal and afterwards diurnal 
pollutions — Occasional impotence — He-establishment by cauterization — 
Relapse — - Cure by the baths of Vernet. 

M. B , a magistrate, of a lymphatico-sanguine temperament, had 

occasionally practised masturbation, but had never committed any venereal 
excesses. He was attacked, for the first time, at the age of eighteen, with 
an eruption on the prepuce which disappeared spontaneously, returned soon 
after, and again disappeared. This eruption was called by his medical 
attendant herpes prseputialis. From that time it continued to return at 
periods of increasing duration, and, at various times, presented circum- 
stances worthy of notice. The eruptions generally appeared on different 
spots, to the number of five or six, and were not, at first, larger than a pin's 
head, but were accompanied by violent itching; by degrees the spots in- 
creased in size and became united, after which they dried up, leaving only 
a degree of redness which soon passed off. The appearance of these erup- 
tions were always preceded, during three or four days, by a sensation of 
lassitude, and of weight at the root of the penis. During the eruption the 
lassitude left the patient entirely, and the sexual impulse and power were 
much greater than usual. The return of the eruption took place, at first, 
every two or three months, then every year, and after that every two 
years; and when M. B consulted me it had not appeared for three 



CUTANEOUS AFFECTIONS. 87 

years. As the eruption appeared more rarely it lost, also, much of its dura- 
tion and intensity. It always yielded to lotions of cold water. 

Two years after the first appearance of the eruption M. B had an 

ulceration on the penis. This was regarded as syphilitic. Still later he 
had two attacks of urethral discharge, after which a swelling at the anus 
supervened. All these symptoms were attacked by a rigid and long con- 
tinued anti-venereal treatment. 

During the twelve years that M. B has been married, he has very 

rarely had sexual intercourse, but he has generally experienced three or four 
nocturnal pollutions in the course of a month. 

For the last four years he has felt greater sense of weight at the root 
of the penis ; spontaneous erections have disappeared ; those which he has 
been able to excite have been very rare, and seldom perfect. Ejaculation 
has always been hurried, and sometimes even has preceded intromission. 
It has never been accompanied with acute sensation. Intercourse has been 
followed by sleeplessness, general prostration, irritation and spasms in the 
stomach, especially if it has taken place in the evening. Nocturnal pollu- 
tions have been very abundant, have occurred almost without erection, and 
have been followed by much more serious symptoms than emission follow- 
ing coitus. For the last two years, nocturnal emissions have become 

gradually more rare, and M. B has noticed, accidentally, on several 

occasions, that he has passed semen whilst at stool, although his bowels 

have not been constipated. On his arrival at Montpellier M. B was 

forty-two years of age; his face was red, and he appeared in good health. 
But his digestion was badly performed; his sleep was disturbed; and he felt 
his memory and intellect much weakened. The progressive loss of power 
in the genital organs was a source of much regret to him. His urine was 
thick and very fetid, it contained a large quantity of mucous flocculi, and 

deposited a sediment of matter resembling semen. M. B told me this 

appearance had been present in it during twelve years. Thus the alteration 
in his urine dated from about the time of his marriage. 

On the sixth of May, 1836, I cauterized the urethra from the neck of 
the bladder as far as the membranous portion ; the effect of the operation 
was prompt and very evident. Sixteen days afterwards the urine was 
perfectly transparent, and the general state very satisfactory. He was then 
compelled to leave Montpellier suddenly. Three months afterwards M. 

B informed me that in spite of the irritation caused by travelling, his 

urine had continued transparent, and that his genital organs had acquired 

an unaccustomed energy. In fact M. B found himself so well that he 

considered it unnecessary to use the mineral waters as I had recommended 
him. 

Two years afterwards M. B had a slight relapse which yielded rapidly 

to the use of the sulphuretted waters of Vernet, near Perpignan. 

I shall not inquire here, whether there was really blennorrhagic 
contagion in this case. I shall only remark that the herpes ap- 
peared a long time before any sexual intercourse had taken place, 
and that its return was accompanied by violent pruritus, and in- 
crease of sexual impulse; intercourse would in consequence take 
place more frequently during the presence of the eruption. 

The singular connexion of the skin affection, intermittent with 
attacks of blennorrhagia, is worthy of notice ; it shows a continual 



88 CAUSES OF SPERMATORRHOEA. 



*ane 



metastasis of the irritation of the prepuce to the mucous membrane 
lining the prostate. As soon, therefore, as the eruption appeared, 
the habitual sense of weight in the prostatic region was relieved, and 
the activity of the genital organs increased ; the symptoms connected 
with the prostate re-appeared when the herpes was cured. As the 
eruption diminished in frequency and intensity, and the intervals 
between its appearance became longer, the functions of the 'genital 
organs diminished, and at length, when the herpes had not come on 
for some time, the patient's impotence was complete. The urine 
was muddy from the period of the patient's marriage ; it seems pro- 
bable, therefore, that the greater frequency of sexual intercourse con- 
tributed to the production of diurnal pollutions. It is also worthy 
of notice, that as the nocturnal pollutions became rarer, the debility 
of the genital organs was shown in a more striking manner, and 
that from this period the seminal discharges during defecation were 

sufficiently abundant to be remarked by the patient. M. B 's 

impotence was not absolute, because the involuntary discharges va- 
ried much in amount. This variation in the symptoms is a charac- 
teristic feature of slight cases of spermatorrhoea, and very probably 
explains the uncertainty of temper in such patients. In the case I 
have just reported it is not to be wondered at, when the intermis- 
sions of the cutaneous affection are taken into account. 

Another very remarkable case in which blennorrhagia occurred 
several times as a consequence of the metastasis of cutaneous affec- 
tions, will be found in my 10th chapter. 

CASE XIV. 

Lymphatic temperament — Various cutaneous eruptions alternating with 
other affections — Habitual bad health — Hypochondriasis — Spermator- 
rhoea undiscovered during twenty -jive years — Cure by sulphuretted baths. 

M. D , of very lymphatic temperament, was subject, in his childhood, 

to chilblains and a cutaneous affection of the scalp; he had also many stru- 
mous abscesses in his neck. About puberty his health became better, but 
he was still subject to attacks of ophthalmia, discharge from the ears, and fre- 
quent cutaneous eruptions of different kinds, which were very difficult of cure, 
and alternated with sore throat or chronic affections of the different mucous 
membranes. He married at the age of twenty-one, and never committed 
excesses of any kind. He has had several children. 

About the age of thirty, tetters appeared on his face, neck, arms, legs, 
scrotum, and perineum; these were sometimes dry and squamous, and 
changed their situation very rapidly. They were often followed by little 
pimples which appeared in different parts of the body, causing great itching ; 
at other times boils followed them and lasted for months. M. I> under- 
went various modes of treatment in order to rid himself of these unpleasant 
eruptions, but without success — some of the remedies even increasing his 
disease. 

By degrees his health became disordered in a more serious manner; he 
experienced successively symptoms of pulmonary catarrh, of gastro-ente- 



CUTANEOUS AFFECTIONS. 89 

ritis, and of chronic cystitis ; he was also subject to frequent attacks of 
rheumatism, and was annoyed by obstinate constipation alternating with 
diarrhoea. His digestion by degrees became difficult, and he was often at- 
tacked with flatulent colic; his bowels were, indeed, always distended by 
flatus, of which he was obliged frequently to relieve himself. When attacks 
of colic came on he seemed on the point of being suffocated ; blood rushed 
to his head; his face became purple; but at length all passed off on the dis- 
charge of immense quantities of flatus, which often continued to escape for 
several hours. 

From this time he ceased to go into society, and saw only his most inti- 
mate friends, and by degrees he became nervous and hypochondriacal. An 
excellent man naturally, he now was ill tempered, peevish, and capricious, 
and he showed great weakness of character and morbid sensibility. A 
slightly interesting tale, or the recital of an instance of courage or devotion 
affected him to a foolish degree, and he was particularly alive to any thing 
he considered an injustice. 

His face was often congested and he complained of stunning sensations, 
for the relief of which leeches were applied to the anus, and he used foot 
baths and other remedies without benefit. At length his legs failed, and he 
was obliged to give up the frequent walks he had previously taken. 

These symptoms were looked on as the forerunners of apoplexy. Leeches 
were again recommended to be applied to the anus, but the patient refused, 
because he had never been benefited by their application. 

Under these circumstances I was consulted, M. D being then fifty- 
six years of age. I was for several days unable to discover the cause of these 
various symptoms, so long and complicated was the history of the com- 
plaint. At last the patient mentioned a tetter which had covered all the 
scrotum, and extended to the perineum and margin of the anus. I then 
inquired if he had ever experienced spermatic discharges during the passage 
of fasces, and I soon learnt from the details into which he entered that he 
had been subject to spermatorrhoea during twenty-five years without sus- 
pecting it. He had always thought that the urethral discharge during 
defecation consisted of mucus, and had never attached the least importance 
to it. These discharges were not habitual nor equally copious at all times, 
and he was often quite free from them during many months. As well as 
he could recollect, these periods of immunity were when he was affected by 
cutaneous eruptions. He even thought that his "humours" escaped with 
the urine when he saw the spermatic discharges reappear, and he then ex- 
perienced in the rectum and bladder a heat and irritation which he was only 
able to relieve by means of injections. From the first occurrence of these 
involuntary discharges his erections and sexual desire had constantly dimi- 
nished, and had left him entirely for several years; this he attributed solely 
to the effects of age. His urine was often muddy and flocculent for a fort- 
night, and then became limpid during a variable length of time. 

All these circumstances combined, were much too clear to leave the slight- 
est doubt as to the nature of the disorder ; I therefore recommended him to 
take the natural sulphuretted waters, and he went to those of Vernet, near 
Perpignan. After seven or eight baths a lively itching came on in his skin, 
especially on the legs. Numbers of small pimples appeared, from which 
oozed for a month so considerable a quantity of reddish serosity, that the 
patient was obliged to surround his limbs twice a day with several folds of 
linen. At length this discharge gradually diminished and the epidermis 
came off in patches over the whole surface of the body. 



90 CAUSES OF SPERMATORRHOEA. 

During this time a complete change took place in the economy: — the 
faeces were passed easily and regularly; the appetite increased; the invo- 
luntary spermatic discharges disappeared; the stomach digested with equal 
facility all kinds of food, and bore the patient's taking wine; his erections 
reappeared, and in fact M. D at fifty-six years of age experienced al- 
most a return to youth. 






In this case spermatorrhoea was unsuspected during twenty-five 
years, and the unhappy patient who thus suffered had passed during 
all the time for a hypochondriac. Enemas and medicines had been 
prescribed for him, without any attempt being made to seek the cause 
of his disease. I hope that these cases will in future receive more 
attention from medical men ; although they do not speedily cause 
death, it must be admitted that they render existence wretched. 

How was it that this patient could so long support so serious a dis- 
ease ? Probably because it was not constant. The spermatic dis- 
charges, in the commencement, seem only to have - appeared when 
irritation occurred in the genito-urinary organs or rectum. At last, 
however, they threatened the patient's life, and suspicions arose of 
the presence of cerebral disease, or at least of the danger of apoplexy. 

Causes. — The cases I have related are sufficient to show the inti- 
mate connexion that exists between the genito-urinary mucous mem- 
branes and the skin, especially that of the scrotum and perineum. 
I do not, however, mean to infer that the connexion between the 
mucous membrane and the skin is more intimate or special in the 
genito-urinary than in the other organs of the body. It depends on 
the same cause, viz. : — the analogy of function between the mucous 
and the cutaneous tissues. In the tenth and eleventh cases which I 
have related, the genito-urinary organs were the last affected; the 
law, therefore, is a general one, but I can only here consider that 
part of it which relates to spermatorrhoea. 

Nevertheless, cutaneous affections alone have not, in most cases, 
been sufficient for the production of this disease, for I have already 
stated that its causes rarely act singly. It is, however, necessary 
to consider them singly when we wish to discover the influence due 
to each, and we ought to take into account all the circumstances 
which may contribute to produce so serious a disorder. 

I have reported in the preceding chapter an example (case ninth) 
of blennorrhagia complicated with cutaneous disease, for the cure of 
which it was necessary to employ special remedies ; in the eleventh 
and twelfth cases, urethral discharges were present in more or less 
severity and frequency. It may appear that I should not have sepa- 
rated cases so much resembling each other, but I have been guided 
in so doing by the greater predominance of one or the other pre- 
disposing affection. 

There is certainly no reason why an individual affected by cutane- 
ous diseases should not expose himself to the risk of blennorrhagic 
contagion, and there is on the other hand every reason why he should 



CUTANEOUS AFFECTIONS. 91 

be easily infected by such exposure ; I think, however, that we too 
generally confound the discharges, to which such persons are subject, 
with ordinary blennorrhagia, and if the patients speak of old cutaneou3 
affections which have disappeared on the occurrence of the discharge, 
we too often smile, and without taking further notice prescribe the 
anti-blennorrhagic remedy which we are in the habit of using in all 
cases. Even well educated and experienced practitioners constantly 
act thus, from not having sufficiently considered special cases ; these 
cases, nevertheless, occur often enough to merit serious attention. 

One of my friends, who had been affected for a long time by a 
pruriginous eruption, consulted an empiric, who ordered an ointment 
to be applied over all his body for its cure. He was scarcely well 
when he married. A few days after, an abundant greenish discharge 
appeared from the urethra, attended by pain, and all the symptoms 
of violent blennorrhagia. At this he was much alarmed, and consult- 
ed me. Knowing his history, I did not share his suspicions, but I 
recommended him to wear flannel from head to foot ; in a few days 
the eruption reappeared, and the discharge subsided spontaneously. 

I have, at this time, under my care, a patient who, at the age of 
fourteen, suffered from an eruption on the scalp ; this disappeared 
about the age of nineteen, and was followed by chronic inflammation 
of the pulmonary mucous membrane. After the cure of this affection, 
pain in the neck of the bladder, accompanied with uneasiness, acute 
cutting pain, and weight in the rectum, came on without any evident 
causes; urethral discharge appeared; the spermatic cord and testi- 
cles became swollen and painful, and the patient is now the victim 
of spermatorrhoea with all its accompanying disorders. 

In another case for which I have been recently consulted, the 
patient had never had sexual intercourse. He suffered from cuta- 
neous affections in early life, and at the age of eighteen experienced 
inflammation of the testicles from excessive excitement caused by 
reading an obscene book, and two years afterwards, after unsuccess- 
ful attempts to obtain the favours of a female, a severe blennorhagia 
occurred, which lasted nine months. 

After these facts we should think twice before we pronounce on 
the nature of a urethral discharge occurring in a person subject to 
cutaneous eruptions, especially when their suppression has previously 
been followed by inflammation of some other mucous membrane. 
Yet we must always bear in mind that these persons are liable, in 
common with the rest of mankind, to the occurrence of blennorrhagia, 
which would even put on, in their particular cases, greater virulence 
than usual, and must therefore greatly increase the predisposition 
of persons subject to cutaneous diseases to suffer from spermatorrhoea. 

We find in these cases, as in those recorded in the second chapter, 
that anti-venereal treatment is useless and frequently injurious. 

Mode of Action.-— In what manner do cutaneous affections operate 
in producing spermatorrhoea? The cases I have reported are suffi- 
cient to show that they act by a metastasis to the mucous membrane 



92 CAUSES OF SPERMATORRHOEA. 



lre - 



of the genitourinary apparatus. Thus the patient suffered from 
peated attacks of urethritis (as in the eleventh case,) acute or chronic 
cystitis (as in the tenth case,) active irritations of the bladder, inflam- 
mation of the testicles (tenth case,) or the prostate, and pains in the 
spermatic cords. We find then in these patients the same symptoms 
that are manifested by those in whom spermatorrhoea has arisen from 
contagious urethritis. The metastasis of cutaneous affections to the 
urethral mucous membrane, therefore, produces the same effects as 
the blennorrhagic virus, and the irritation extends in the same course 
along the seminal passages. 

Irritation of the Rectum. — Several of my patients have suffered 
from affections of the rectum of which I have given no account in the 
preceding chapters. These affections have consisted of a sense of 
heat, darting pains, uneasiness, and a feeling of pulsation extending 
more or less high in the intestine (as in the twelfth case.) These 
symptoms show that the cutaneous irritation had extended to the 
mucous lining of the rectum, as well as to that of the genito-urinary 
organs. Such a complication must increase greatly the chance of 
spermatorrhoea occurring, by provoking a spasmodic contraction of 
the rectum, whence results an obstacle to the passage of fseces, and 
a disposition to contraction in the seminal vesicles. 

In the next chapter I shall consider the causes of spermatorrhoea 
which are connected with the rectum, and I shall only now observe, 
in passing, that their symptoms must not be confounded with those 
arising from irritation of the prostate. In both cases, constipation 
and a sense of weight, heat, and uneasiness in the rectum may be 
present, but when these symptoms arise from an eruptive affection, 
an intolerable itching, and heat at the edge of the anus are felt, and 
on examining the parts, they are found red, excoriated, and wet ; on 
drawing out the folds of the skin, a mucous and sometimes a puru- 
lent discharge is perceptible, and the portions of mucous membrane 
which can be brought into view are seen to be in the same condition : 
— in a word, the margin of the anus presents unequivocal marks of 
cutaneous disease. 

It is important to establish this distinction, because, in the first 
case, cauterization of the prostatic portion of the urethra may put an 
end to the chronic inflammation going on there; but, in the second 
case, symptoms which have their seat in the rectum are due to a 
special affection of its mucous membrane. It is, indeed, true that 
this affection is similar to that of the urethra, and that it arises from 
the same cause; but the cure of the urethral inflammation would 
have no effect on that present in the rectum, and we shall presently 
see that the latter may suffice to excite or keep up spermatorrhoea 
to a sufficient extent to alter the health seriously. 

Treatment. — The only means that have been successfully employed 
in cases of this nature, are cauterization and the use of the sulphu- 
retted waters. 



( 93 ) 



CHAPTER V. 

CAUSES OF SPERMATORRHOEA. 

Influence of the Rectum. 

I have hitherto examined those causes which influence the sper- 
matic organs by their direct action on the urethral mucous membrane. 
I now proceed to consider such as act on the seminal vesicles by the 
mechanical and sympathetic influence of the rectum. 

CASE XV. 

Spermatorrhoea from a mechanical obstacle to defecation- — Division of the 
stricture — Rapid and complete cure. 

Nicholas G , the guard of a diligence, of strong constitution, at the 

age of twenty-five contracted chancre, followed by bubo and warts. This 
attack of syphilis was treated with mercurials, without the patient giving up 
his employment, and, notwithstanding the fatigue consequent on his fre- 
quent journeys, at the expiration of six weeks all the symptoms had disap- 
peared. Shortly afterwards he experienced difficulty in defecation, which 
slowly increased, so that in the course of four or five years considerable 
efforts were necessary to evacuate the rectum. The faeces were flattened, 
like a riband, four or five lines in width and about a line in thickness. 

From this time Gr 's health became gradually disordered; his appetite 

diminished, his digestion was impaired, and accompanied with the develop- 
ment of flatus; he lost flesh, and his weakness increased daily; his memory 
was impaired, and the genital organs underwent the same changes in their 
functions. When he first consulted me he had scarcely any venereal desires, 
his erections were imperfect, coitus was rarely possible, and ejaculation was 
long in taking place ; sometimes it did not even occur at all, and it was never 
accompanied by any lively sensation. 

The concurrence of all these symptoms convinced me of the presence of 
spermatorrhoea. The patient told me that for four years he had been in the 
habit of passing semen while at stool, and that its discharge in general bore 
a proportion to the efforts necessary for the expulsion of the faeces ; on this 
account, in order to render them as fluid as possible, he had reduced himself 
to a vegetable and milk diet. He had often attempted to use enemata, but 
had been unable to succeed. 

The abundant spermatic discharges had so worn this patient out, that at 
the age of thirty-four he presented the appearance of a man aged sixty. 

On examination, I discovered, about two inches from the anus, a nearly 
circular obstruction, of about half a line in thickness, having an irregular 
opening in its centre which would barely admit the extremity of the fore- 



94 CAUSES OF SPERMATORRHOEA. 






finger. This kind of diaphragm obstructed the passage of faecal matter ; it 
was thin and soft, and felt like a cicatrix. 

I made transverse incisions through the obstruction by means of a 
straight probe-pointed bistoury passed along the index finger. These in- 
cisions were of very trifling depth, and I afterwards dilated the opening 
by introducing my finger deeply, and pressing it forcibly in the direction 
of each wound, until by tearing I reached the walls of the intestine. Four 
loose flaps resulted from this operation, and I prevented their re-union by 
the frequent introduction of my finger. The operation was attended with 
very little pain or loss of blood. Some time afterwards I showed the 
patient how to introduce a rectum bougie, of sufficient size to dilate the por- 
tion of gut which had been operated on ; this I advised him to practise daily 
for some time. This simple means proved sufficient to procure separate cica- 
trization of the four flaps, after which the expulsion of the faeces took place 
without difficulty, and the spermatic discharges ceased. All his functions 

were soon restored to their natural state, and Nicholas Gr resumed his 

former occupation. 

This case gives a very clear view of the mechanical influence of 
constipation in producing spermatic discharge during the passage of 
feces. The sole cause of the spermatorrhoea was the membranous 
obstacle above the sphincter; and the discharge was caused simply 
by mechanical pressure on the seminal vesicles during the violent 
efforts the patient was compelled to make in order to force the feces 
through a narrow opening. As soon as the obstacle was removed, 
the spermatorrhoea ceased, and all the symptoms arising from it dis- 
appeared. The effects of mechanical compression were in this case 
then quite unmistakeable. 

Coitus was very long before ejaculation took place; sometimes 
even the completion of the act was impossible, and it was never at- 
tended by lively sensations. The cause of all this was that the 
seminal vesicles contained little and badly formed secretion; but 
these organs were not in a state of irritation, and the ejaculatory 
canals were neither irritable nor relaxed. In most cases of diurnal 
pollution, ejaculation is, on the contrary, very rapid, because the 
spermatic organs are either irritated or relaxed, if they are not at 
the same time in both these conditions. 

CASE XVI. 

Spermatorrhoea induced by chronic diarrhoea^ and kept up by a mechanical ■ 
obstacle to defecation — Removal of a scirrhous tumour from, the anus — 
Rapid and perfect cure. 

M , of good constitution, entered the army at the age of seventeen, 

and served for eighteen years, during which he was exposed to considerable 
hardships. He also committed excesses of all kinds. His health, however, 

continued excellent. In 1814, M , then aged thirty-five, contracted 

blennorrhagia which he neglected; the discharge diminished, but did not 
entirely cease before 1816, when he quitted the army. In 1820, M 



INFLUENCE OF THE RECTUM. 95 

married, but did not indulge in any excesses. Some time afterwards, having 
been engaged as concierge to a club, he passed many nights almost without 
lying down. In 1824 he was suddenly seized with violent colic, which was 
relieved by means of emollient injections, repeated baths, and a severe regi- 
men, but which did not entirely leave him. 

Two years afterwards he had a severe hemorrhage from the rectum, ac- 
companied with very painful tenesmus, during the violent spasms of which 
he noticed that he passed semen. This hemorrhage relieved the colicky 
pains he had suffered from, but a dysentery remained, which kept up the 
tenesmus and with it the involuntary seminal emissions, and caused the 
prolapse of several hemorrhoidal tumours with eversion of the mucous mem- 
brane of the rectum. From this period M ; s health became more and 

more disordered; he lost his habitual spirits together with his sexual appetite, 
and his sight as well as his memory and physical strength became weakened, 
so that in 1827 he was obliged to give up his occupation of ^concierge. 
During the years 1827 and 1828, the chronic diarrhoea decreased in severity, 
and in 1829 it had become much less frequent. At length, in 1830, it 
was replaced by a very obstinate constipation, which in its turn also became 
the cause of spermatorrhoea, and increased the swelling caused by the he- 
morrhoids and the prolapsed mucous membrane of the rectum. This swell- 
ing was irreducible; it increased in hardness, was irritated by the friction 
of his clothes, and at last assumed a schirrhous consistency. Its presence 
alone formed a considerable obstacle to defecation. On the 28th of March, 

1831, M applied at the hospital St. Eloi, in the following condition : — 

He was fifty-one years of age; extremely pale; his face pale yellow; skin 
woolly; hair black; weakness excessive; sensibility very great; profound 
melancholy; habitual hypochondriasis; digestion difficult, especially after 
the use of animal food; defecation rendered troublesome by a red hard 
swelling, five or six lines in diameter across its base, projecting about an 
inch, and occupying about half the circumference of the anus; involuntary 
discharges of semen during the efforts necessary to procure a faecal evacua- 
tion; the emission of urine followed by a discharge of a glairy, limpid, and 
sticky matter; no erections during a long period; absence of all sexual im- 
pulse; frequent attacks of vertigo; dazzling of the eyes; buzzing in the 
ears; attacks of heat towards the head from the slightest cause. The 
tumour of which I have spoken resembled a large cock's comb; contracted 
hemorrhoids were situated around it; and it seemed to have arisen from the 
prolapsus of internal hemorrhoids, which had brought down with them a 
portion of the mucous membrane of the rectum. The contraction of the 
sphincter ani had prevented the return of this tumour, and had increased 
its swelling, and the friction of the patient's clothes had caused repeated in- 
flammation and degeneration of its tissue. The base of the tumour occupied 
more than half the circumference of the anus, and extended above the 
sphincter ani. It was about six lines in thickness, and its feel was schir- 
rous ; a sanious discharge exuded from its surface, some points of which had 
even begun to ulcerate. It was, therefore, evident that no time should be 
lost if it were intended to remove this tumour; the patient was anxious for 
the operation, and had previously asked several surgeons to perform it ; but 
these gentlemen had refused on account of the depth to which the diseased 
tissue extended. 

By gentle and gradual traction on the tumour I was able to bring it en- 
tirely through the sphincter, so as to bring the healthy mucous membrane 



96 CAUSES 0E SPERMATORRHOEA. 

into view. On the 25th of March, therefore, I commenced its removal by 
an incision in the healthy mucous membrane, and to arrest the severe he- 
morrhage which ensued, I cauterized the bottom of the wound with a fine 
heated iron. The tumour was then dissected out, the parts being touched 
with the actual cautery as they were divided. After the entire removal of 
the tumour, the greater portion of the wound ascended within the sphincter. 

Slight inflammatory symptoms supervened, which yielded to bleeding, &c, 
suppuration was established, and the cicatrization of the wound was com- 
pleted by degrees. The first few days after the operation the patient was 
unable to void his urine without the use of the catheter, and for some time 
afterwards he micturated very frequently. 

On the first of May cicatrization was nearly completed, the faeces had re- 
gained their normal consistence and were passed daily without difliculty, 
their passage no longer giving rise to involuntary spermatic discharge. The 
patient regained his strength and spirits; his appetite returned, and his di- 
gestion was performed easily ; his strength and stoutness increased daily. 
About the middle of the month his erections re-appeared during the night, 
and afterwards became more frequent and prolonged; his cerebral functions 
followed the same course in their re-establishment; the dazzling of sight and 

cerebral congestions disappeared ; and M left the hospital on the 24th of 

May, perfectly restored to health. 

Three years afterwards, when I was summoned to Clermont to preside 
over a medical inquiry, M called on me ; I recognised him with difli- 
culty, so much was his countenance changed. It is scarcely necessary for 
me to say, that he had resumed his conjugal duties, and his occupation of 
concierge. The cicatrix of the anus was thin and soft, and did not interfere 
with defecation. 

The latter part of this case exactly resembles the preceding one, 
and the results of the operation prove that the involuntary spermatic 
discharges were only kept up by the mechanical obstacle to defeca- 
tion. 

But the diarrhoea which had caused the prolapse of the hemor- 
rhoids, and the formation of the schirrous tumour, was also accom- 
panied by frequent involuntary emissions. At this time, then, the 
seminal vesicles could not have been subjected to compression, as the 
faeces were liquid, and remained a very short time in the rectum; 
we must, therefore, admit that the seminal vesicles participated in 
the irritation of the rectum — that they were affected by the spas- 
modic contraction which took place in the gut — in a word, that they 
were influenced by the tenesmus. 

This case, then, presents a remarkable instance of the double in- > 
fluence possessed by the rectum over the seminal vesicles ; in the 
beginning of the disease this influence was essentially vital ; at its 
termination it was simply mechanical. Both phenomena produced 
the same results, but they were quite sufficiently distinguished from 
one another not to be confounded together. 

It was worthy of remark, also, that the patient, immediately after 
the operation, was unable to pass his urine without the assistance of 
a catheter, and that after a short time he experienced a frequent de- 



INFLUENCE OF THE RECTUM. 97 

sire to micturate. These two phenomena show the intimate con- 
nexion that exists between the anus and the neck of the bladder. 

This case, then, exemplifies the influence of the rectum over the 
urinary organs, in both its different forms. 



CASE XVII. 

Hemorrhoids from the age of puberty — Difficulty in evacuating the rectum 
at the age of twenty-eight — Spermatorrhoea — Cure. 

M. A , of a sanguine temperament, at fifteen years of age was addicted 

to masturbation; soon after he had a discharge of blood from hemorrhoids, 
which he regarded as a consequence of his injurious habit, and consequently 
abandoned it sufficiently early for his health to remain uninjured; but the 
hemorrhoids teased him much, especially when some time after he entered 
the army. They were relieved, however, after a campaign in Spain, where 
the patient suffered much from heat. By returning to his home and by 
leading a less active life, he hoped with care to rid himself of his troublesome 
affection; the reverse happened, however — his diet being more stimulating 
and his habits being sedentary, the hemorrhoids increased in number and 
size. His stools were followed by a more or less abundant discharge of blood. 
The internal hemorrhoids were protruded and formed a voluminous and 
painful mass, which could only be reduced by a long continued pressure. 
After a time these hemorrhoidal tumours becoming irritated and swollen 
presented an obstacle to the discharge of faeces ; a larger portion of intestine 
protruded, and was returned with great difficulty. The patient now perceived 
that in his efforts at stool he passed a large quantity of semen, his health 
broke up by degrees, he felt debilitated, his digestion became disordered, his 
sleep was broken and unrefreshing; his temper was soured, he often experi- 
enced sensations of stunning, vertigo, and sometimes even fainting fits. 

Emollient injections, baths, and demulcents appeared to benefit him at 
first, but he soon perceived that they increased the relaxation of the parts, 
and favoured both the prolapsus of the rectum and the spermatic discharges. 

This state had lasted four months, when the patient first consulted me. 
He was twenty-eight years of age, and had the appearance of being forty; 
his muscles were well developed, but he was, notwithstanding, without 
strength or energy. I first relieved the irritation of the rectum by lave- 
ments of decoction of poppy heads, and afterwards used slightly stimulating 
ointments containing balsamic applications, at the same time that quinine 
and preparations of iron were administered. 

. Under this treatment the mucous membrane of the rectum by degrees 
regained its tone; the hemorrhoids became less sensitive and less voluminous, 
and many of them withered away. The prolapsus of the rectum disappeared 
gradually, and the seminal discharges diminished, at the same time removing 
the symptoms that depended on them. 

Hemorrhoids at the early age of fifteen are rare ; I cannot, how- 
ever, believe that masturbation alone caused their appearance in this 
patient, but I think it probable that he had a considerable pre-dispo- 



98 CAUSES OP SPERMATORRHOEA. 

sition to them. I do not suppose that the habit he practised for a 
short time in his youth had any influence in causing the spermator- 
rhoea, for it is very easy to account for spermatic discharges in such 
a case without referring to very remote causes. We must then re- 
gard this case as another example of the influence which obstruction 
to the passage of faeces exercises on the seminal vesicles. 



CASE XVIII. 

Blennorrhagia, Constipation — Fissure of the anus — Discharge of semen at 
stool — Profound hypochondriasis — Desire of committing suicide — Diar- 
rhoea — Cure of the fissure of the anus — Disappearance of the other symp- 
toms. 

At the age of twenty-four F. B— — contracted blennorrhagia, which was 
accompanied with weight in the region of the prostate. By leeches and 
baths the pain was relieved, and the discharge reduced to a slight gleet. 
Soon afterwards the left testicle became swollen and very painful, and the 
discharge increased in consequence of energetic and long continued erec- 
tions. The patient used leeches and hip baths, and the swelling of the tes- 
ticle diminished, but the discharge continued. For three or four years this 
testicle continued very tender; it swelled on several occasions, and became 
painful in consequence of slight venereal excitement, the urethral discharge 
increasing at the same time. These phenomena returned every spring during 
four years. 

In order to cure these symptoms F. B took the Bob de Laffecteur, 1 

after the second bottle of which, an obstinate constipation supervened. 

Defecation now became very painful, and the faeces were covered with 
blood. The patient had recourse to enemata without benefit; during their 
administration he felt as if the " anus were torn by heated razors." This 
state had lasted several months when he experienced attacks of vertigo 
after going to stool, and sudden attacks of cerebral congestion, passing off 
rapidly, either while walking or engaged in any kind of employment : his 
moral condition became affected ; he fell by degrees into a deep melancholy; 
depressing thoughts arose before him incessantly ; he seemed compelled to 
seek solitude and darkness ; he felt a horror of suicide, but nevertheless he 
seemed always to be driven towards it. Wrapped up in his melancholy 
thoughts he spoke to no one, and if his friends endeavoured to attract his at- 
tention he responded to them rudely; he felt his venereal desires constantly 
diminish; but this did not affect him so much as his moral position; he held 
suicide in abhorrence, yet he felt impelled towards it in spite of his will; his 
reason wandered until at length he believed himself possessed by the devil, 
and he spent hours together in praying to be delivered from his tempta- 
tions. A constant feeling of hunger annoyed him, though he ate often and 
greedily; his digestion was painful and laborious. Notwithstanding the 



1 Rob de Laffecteur is composed of a strong decoction of the Arundo Phragmitis, 
or bulrush, with sarsaparilla and aniseeds, evaporated, and made into a Rob or syrup 
by the addition of sugar. To this a solution of the bichloride of mercury is afterwards 
added. 



INFLUENCE OF THE RECTUM. 99 

repeated use of leeches, demulcents, and baths, these symptoms increased 
to a frightful extent; his sufferings indeed were generally greatest on quitting 
the bath. One day whilst at stool he noticed the evacuation of a quantity 
of whitish and viscid matter which he fancied was semen; from that time 
his attention being called to the fact, he observed that he seldom had an 
evacuation without more or less spermatic discharge; he noticed also that 
the matter in its passage produced a kind of tickling accompanied with heat 
in the urethra. 

After having passed six months in this deplorable condition, the patient 
suffered from a serious attack of indigestion, followed by a very copious 
diarrhoea that lasted a fortnight, and reduced him to an extreme state of 
debility; but after its relief the faeces regained, by degrees, their normal 
consistence, and were then passed without pain or streaks of blood; the 
spermatic discharges which had been excited by efforts at stool no longer 
took place, and all the moral and physical symptoms above mentioned were, 
by degrees, completely and spontaneously dissipated. Several years after- 
wards F. B enjoyed excellent health, all his functions, without excep- 
tion, being perfectly performed. 

In this case the blennorrhagia caused inflammation of one testicle 
and developed the susceptibility of the genital organs ; consequently, 
therefore, it predisposed them to the occurrence of spermatorrhoea ; 
but the constipation brought on by the use of Rob de Laffecteur evi- 
dently was its immediate cause. The symptoms which ordinarily 
accompany fissures of the anus appeared soon after ; and afterwards 
those arising from spermatorrhoea. The course of events was pro- 
bably as follows : — after prolonged constipation a hard copious motion 
distended the mucous membrane lining the anus, more than usual ; it 
gave way ; from that date defecation having become painful the pa- 
tient put it off as long as possible ; the hardened and accumulated 
faeces in their turn increased the fissure in the mucous membrane : — 
thus it is that fissures of the anus are usually produced and kept up. 
The diarrhoea, which lasted fifteen days, allowed the cicatrix in the 
mucous coat of the gut to become firm. It is easy, therefore, to 
account for the appearance and cessation of the seminal discharges, 
together with the anomalous symptoms from which the patient suf- 
fered during six months. 

I have already shown hypochondriasis, in many forms, as a conse- 
quence of spermatorrhoea, but in no case previously reported did it 
present characters like those in the case before us. This young man, 
naturally of a good disposition, was beset, during the whole course of 
his disease, by the most frightful propensities ; he was so revolted by 
them that the loss of his health seemed nothing when compared with 
the mental torture they entailed on him. His reason was so shaken 
that he considered the intervention of the devil to be the only mode 
of explaining his evil impulses ! To what must we refer an aberra- 
tion of intellect which might have produced such fatal results ? 

But to return to the consideration of fissures of the anus. This 
disease, without doubt, often excites spermatorrhoea. The silence of 



100 CAUSES OF SPERMATORRHEA. 

authors on the subject proves nothing, for, notwithstanding the ac- 
tivity with which during years I have sought the causes of sperma- 
torrhoea, I rarely, until lately, profited by the opportunities I had 
of questioning patients on this point. When the violent efforts 
necessary to empty the rectum, the acute pain and spasmodic con- 
tractions of which it becomes the seat, and the disturbances which a 
very slight excoriation produces throughout the economy, are taken 
into account, I think it will be readily allowed that fissures of the 
anus may frequently induce abundant spermatic evacuations. 

The patients fear to go to stool, on account of the pain the passage 
of the feces produces ; these, therefore, accumulate and harden in 
the rectum; when at length the irritable intestine contracts to expel 
its contents, their passage tears open the fissure; the sphincter, 
irritated by this increase of pain, contracts spasmodically, and a 
contest is thus established between the sphincter and the muscular 
walls of the intestine, aided by the abdominal muscles. The efforts 
to evacuate the intestine are so violent and prolonged that respiration 
is suspended ; the face becomes injected and purple, and blood appears 
ready to start through the skin. It is difficult to conceive how the 
seminal vesicles can, under such circumstances, escape compression. 

We must, also, take into account the fixed pain at the verge of 
the anus, and the spasmodic state of contraction into which all the 
neighbouring muscles are thrown; for these phenomena act more or 
less on the genito-urinary organs. Lastly, fissures of the anus are 
soon followed by changes in the physical and moral state of the 
patients, of too serious a nature to be attributed only to the pain 
they cause. I have seen young men arrive at the hospital in a con- 
dition of weakness and mental despondency, contrasting strongly 
with the size of their muscles, and the colour of their complexions. 
It is especially after they have evacuated the bowels that such pa- 
tients feel most worn out, broken-spirited, and depressed; they have 
generally lost all venereal desire ; their erections are weak, rare, 
and incomplete. I regret that I have not recorded these cases, but 
I remember their circumstances perfectly, and all things conduce to 
make me attribute the symptoms to spermatorrhoea ; however this 
may be, it is a subject for further research to which I wish to call 
the attention of the profession. 

CASE XIX. 

Horse exercise — Constipation — Spermatorrhoea — Impotence — Frequent and 
violent attacks of cerebral congestion — Ascending douches — Cauterization 
— Sulphur laths — Hot and cold douches on the loins and perineum — Cure. 

M. De B consulted me in the month of May, 1834, respecting a 

cerebral affection, on whose nature distinguished physicians could not agree, 
but which all regarded as very serious. 

He was of a middle height, with a large chest, and a well developed 
muscular system; his hair brown and curly, his beard thick, his face full 



INFLUENCE OF THE RECTUM. 101 

and deeply coloured. Notwithstanding these signs of apparent strength and 
health, I noticed that his knees were slightly bent, and that he was unable 
to remain long standing without shifting the weight of his body from one 
leg to the other; his voice was weak and husky; the motions of his tongue 
seemed embarrassed, and he articulated his words in a confused manner; his 
attitude was timid, and his manner had something of incertitude and fear; 
he had been married fifteen days. 

His mother-in-law and his young wife, who accompanied him, informed 
me that within this period he had several attacks of congestion of the brain, 
during which his face was highly injected. At the first of these attacks 
the surgeon, called in the night, had bled him to the extent of three pounds, 
in order to prevent apoplexy ; repeated venesection, and the frequent ap- 
plication of leeches, had relieved such attacks of congestion, but had not 
prevented their recurrence. The patient had become subject to attacks of 
vertigo, and was unable to look upwards without feeling giddy; his legs 
had become so weak that he had fallen several times, even when walking 
on level ground; his ideas had lost their clearness, and his memory failed 
rapidly. 

These symptoms had spread consternation through both the family of my 
patient and that of his wife, especially as several practitioners of reputation 
were agreed as to the existence of some serious disease of the brain, although 
they could not decide as to its nature. Most of them, however, were inclined 
to suspect ramollissement. 

The countenance of the patient during this recital, the coincidence of the 
congestion with the period of his marriage, and the bad effects of blood- 
letting, made me suspect the nature of the disorder, and induced me to 
question the patient separately. "When we were alone he told me, stam- 
mering, that an unexpected occurrence, immediately after his marriage, 
had at first prevented any conjugal intimacy, and that afterwards he had 
found himself completely impotent. He attributed this misfortune to the 
attacks of cerebral congestion, and to the bleedings he had undergone. On 
further inquiry, however, I discovered that he was affected by diurnal pollu- 
tions. 

The following is the history I obtained from this patient by dint of ques- 
tioning : — at the age of sixteen he possessed a very strong constitution, and 
an ardent and passionate character. At school he contracted the habit of 
masturbation, and at the end of three months he had frequent nocturnal 
pollutions, with pain in the chest, and troublesome palpitations, which 
warned him of the danger of the vice, and he renounced it for ever. When 
he became free from the restraints of school, he subdued the ardour of his 
temperament by the most violent exercises — especially that of the chase — 
and he attached himself to agricultural pursuits with much energy. 

This new mode of life so completely re-established his health, that he was 
tormented by energetic, and continual erections, to subdue which he em- 
ployed river baths, even in the coldest seasons. He never committed excesses 
of any kind, and had never suffered from any blennorrhagic or syphilitic 
affection. 

In 1831, the erections were slightly mitigated, but he became very much 
constipated, which he attributed to the constant use of horse exercise. 

In 1832, he experienced some numbness and creeping sensations in his 
feet and legs. 

In 1833, frequent dazzling of sight occurred, with vertigo, difficulty of 



102 CAUSES OF SPERMATORRHOEA. 

vision, and flushes of heat, towards the head and face; the patient attributed 
all these symptoms to the effects of his still increasing constipation. 

At the same time that these symptoms occurred, the patient's erections 
became rarer, less energetic, and after a time, incomplete ; his fitness for 
intellectual labour diminished; the cerebral congestions became more fre- 
quent, and more severe; his face became habitually very red; his head 
burning ; an almost constant fixed pain came on in the orbits, and his cha- 
racter became fickle and contradictory. 

His family physician , attributing all these disorders to a state of plethora, 
caused blood to be drawn several times, without benefit. 

In March, 1834, M. De B engaged himself to a young lady, who 

lived about two leagues from his estate ; and in order to visit her without 
neglecting the care of his property, he was obliged to make long and fre- 
quent journeys on horseback; shortly before his marriage, these journeys 
became so frequent that he might be said to pass the greater part of his 
time on horseback. His constipation now increased to such a degree that 
he passed forty days without faecal evacuation; during his efforts at stool 
he passed semen in large quantities, and in jets, although the penis remained 
flaccid. He had previously, several times, noticed the same occurrence, but 
as he attributed it to his long continued continence, he paid little attention 
to the circumstance. His urine was constantly muddy; it was passed slowly, 
and with difficulty, and threw down a large quantity of thick and flocculent 
deposit. 

M. De B awaited the period of his marriage with a vague uneasiness, 

of which he could not imagine the cause ; he was much attached to his be- 
trothed, but, nevertheless, he experienced more embarrassment than pleasure 
in her society. 

I have already stated what occurred after his marriage; I should add, 
that having examined the genital organs, I found them, contrary to my 
expectations, of unusual development, the testicles were large and firm, but 
the scrotum was slightly relaxed. The patient experienced a strange tingling 
in the organs, and at times felt as if they were compressed by a hand of iron. 
These sensations increased when near his wife, and the penis diminished in 
size, and became retracted towards the pubes, in proportion as he endeavoured 
to excite erection. 

The union of all these circumstances could not permit any doubt to remain 
on my mind as to the nature of his disease; it became evident that all idea 
of cerebral affection must be abandoned, and that the diurnal pollutions, with 
all the symptoms of which they were the cause, must be referred to the 
patient's constipation. 

The first indication to be fulfilled, therefore, was to relieve the constipa- 
tion; indeed I hoped this was all that would be necessary: the youth of 
the patient, the development of the genital organs, and the strength of his 
constitution induced me to suppose that his cure would be prompt and easy. 
Things did not, however, follow so simple a course. 

The next day the patient began to use ascending douches; and was put on 
a vegetable diet, with iced milk. 

The first douches caused the evacuation of an immense quantity of faecal 
matter in lumps, as hard as bullets, and it was not until after the sixth 
douche that the faeces were of normal consistence; I then caused the tem- 
perature of the water to be lowered to 25° of Reaumur's 1 scale, and after- 

1 About 88° of Fahrenheit. 



INFLUENCE OF THE RECTUM. 103 

wards to 20° Reaumur. 1 The last few douches were given at 16° Keaumur. 2 
After the twelfth douche had been administered, they were omitted, the 
bowels having acted regularly every day, without the necessity for the slightest 
straining. 

By this time the patient's countenance had lost its purple tint, and pre- 
sented a more natural appearance : the stunning sensations of which he had 
complained diminished by degrees,and at length disappeared entirely; his 
legs regained their strength, and he was able to continue in a standing pos- 
ture for a long time without fatigue, and to take long walks without incon- 
venience ; his voice resumed its natural tone, his eye regained its expression, 
and all his motions acquired firmness. 

At the expiration of a fortnight the spermatic discharges during defeca- 
tion had ceased entirely; but his urine still continued thick. His erections 
had already acquired sufficient energy to make him believe himself cured, 
but ejaculation took place almost instantaneously. The use of ice and cold 
lotions did not ameliorate his condition. 

Such was M. De B ; s state at the end of a month; when, in order to 

act directly on the orifices of the ejaculatory ducts, I determined to cau- 
terize the prostatic portion of the urethra. As soon as the inflammation 
had subsided, his erections became more perfect and energetic; yet ejacu- 
lation still took place too rapidly. The period for using the mineral waters 
having arrived, I sent M. De B — ■ — to Aix, in Savoy, where I visited him 
shortly after. He had experienced very little benefit from the use of the 
waters, either externally or internally. 

I now prescribed douches, alternately very warm and very cold, on the 
perineum and loins, the spout being changed when the sensation, either of 
cold or heat, became very intense. The bath was ended, after about twenty 
or twenty-five minutes, by the cold douche, and the patient's skin remained 
highly injected for some hours afterwards. 

The effects of these douches were conclusive; after the first, the patient's 
erections acquired a degree of vigour and duration which reminded him of 
his early torments. He continued the use of the douches for some days 
after his re-establishment; and when he left Aix the functions of his genital 
organs were perfect. Ejaculation was a good deal protracted by the use of 
the douches. 

I have entered into a somewhat lengthy detail of this case, because 
the subject affects gravely the most serious interests of society, as 
well as the happiness and peace of families. Besides, I confess that 
I was much interested by the unhappy position of a young man 
whose misfortune was undeserved, and could not have been foreseen, 
as well as by that of his wife — a young woman scarcely of age, who 
was obliged to enter into the most unpleasant details. 

It is evident that in the case of M. De B , the constipation was 

the cause of the involuntary seminal discharges. The patient had 
practised masturbation it is true, and nocturnal emissions followed; 
but he had continued the vice only three months, and his health, 



1 About 81° of Fahrenheit. 2 About 68° of Fahrenheit. 



104 CAUSES OF SPERMATORRHEA. 

though disordered for a short time, was soon re-established by the 

use of violent exercise. M. De B was even tormented during 

several years by erections, which must have been very energetic, *if 
we may judge by the means he took to subdue them. From this 
time he had never committed any kind of excess, and he had never 
suiFered from either blennorrhagia or syphilis. There is then no 
circumstance in the history of his life, except his constipation, which 
would account for the involuntary discharges. 

But to what is this constipation to be referred? After all I could 
learn from the patient concerning his mode of life, I could only refer 

it to his constant horse exercise. In fact, M. De B ■ sometimes 

passed whole days on horseback, either for the purpose of hunting, 
or of superintending the management of his property. Shortly 
before his marriage his rides became more frequent and longer, and 
his bowels at this time did not act during forty days. The weakness 
of his legs, the stunning sensations, &c, increased in proportion as 
his costiveness became more confirmed. 

This case recalls to my mind the well known observation of Hip- 
pocrates on the impotence of the Scythians, and I have no doubt 
that his opinion was founded on analogous facts. I shall treat this 
subject more fully in another place; but since at present I am con- 
sidering the causes of spermatorrhoea which act on the seminal 
vesicles through the influence of the rectum, I report this striking 
case, showing the effects of long continued horse exercise. 

M. De B was accustomed to nutritious food, and of a well 

marked sanguineous temperament; he had a large chest, powerful 
muscles, and a highly injected countenance; it is therefore by no 
means extraordinary that he should have been bled frequently for 
the relief of the cerebral congestions to which he was subject. On 
the night of his marriage the blood rushed to his head with greater 
force than ever, so that an attack of apoplexy was much feared ; the 
weakness of the legs, the frequent falls, and the attacks of vertigo, 
were therefore afterwards attributed to an advanced stage of disease 
of the brain. This was a very natural opinion, but it was an incor- 
rect one; I doubted it from the commencement, although the patient 
was brought to me in consequence of a supposed cerebral affection. 
I formed a different impression, because I had previously seen many 
analogous cases. There exists in all these patients something pe- 
culiar in the expression of the eyes, in the position, in the voice, 
and in the general appearance; something of timidity and bashful- 
ness which I am unable to express, but which is instantly recognised 
by the experienced, although perhaps it is incapable of explanation. 
However this may be, the relation of the above case should draw 
attention to the subject. 

I admit that venesections seemed to be clearly indicated in the case 

of M. De B , but the loss of blood never produced good effects, 

either immediate or remote; and by analyzing the case carefully his 
attendants would have seen that under this treatment the attacks in- 



INFLUENCE OF THE RECTUM. 105 

creased in frequency. But pre-convictions throw a thick veil over 
the most acute perceptions. 

The ascending douches put an end to the constipation ; but free- 
dom of faecal evacuation did not suffice to cure the disease. The 
seminal discharges, during the passage of faeces, diminished, indeed, 
or, perhaps, entirely ceased, but the patient's urine remained thick 
and muddy, and his erections were incomplete. The application of 
ice and of the nitrate of silver, and the use of sulphureous waters 
were not sufficient to effect his cure ; yet there could not have ex- 
isted any organic change in his genital organs. We can therefore 
only attribute the continuance of the seminal discharge, during the 
emptying of the bladder, to relaxation of the ejaculatory canals, 
produced by their long habit of allowing the semen to escape in a 
passive manner — showing how necessary it is to put an end to the 
habit as early as possible. 

The alternate use of hot and cold douches on the loins and perineum 
produced a sudden and decisive change in this as in many analogous 
cases ; I shall therefore return to their consideration by and by. At 
present I must only remark, that they should never be employed so 
long as any irritation of the genital organs exists, as under such cir- 
cumstances they produce the most unfavourable effects. 

CASE XX. 

Lengthened exposure to severe cold — Incomplete paralysis of the rectum 
—Seminal discharges during defecation — Cure by the application of 
galvanism. 

M. V , aged twenty-nine, a captain in an infantry regiment, had suf- 
fered from five or six attacks of blennorrhagia, and afterwards from a chancre, 
for the cure of which he took a considerable quantity of the bichloride of 
mercury. At the end of the treatment, in 1822, he left Metz, to go to 
Spain. During his journey he was detained three weeks at Lyons, in con- 
sequence of a disorder of which the most prominent symptom was obstinate 
costiveness accompanied by fever. During the remainder of his journey he 
was obliged, for the first time, to support his left testicle, the veins of which 
were varicose. During the whole campaign he did not suffer from any other 
disease except occasional hemorrhoids. 

After having endured the fatigues of war without disorder, M. V , 

whilst returning to France, was exposed during an entire night to ex- 
treme cold, being at the same time very lightly clothed. The next day he 
felt acute and darting pains in his legs, and these were soon followed by a 
feeling of cold, referred chiefly to the under part of the left hip joint, and 
to the hypogastrium. 

^ From this period a new train of symptoms appeared. The patient felt 
his legs daily becoming weaker; he was subject to obstinate constipation. 
It seemed to him as if the powers intended for the expulsion of the fa3ces 
were paralyzed; and he experienced, moreover, in the distended intestine, 
a feeling of elastic re-action, rather than one of muscular contraction. 
Abundant seminal discharges attended his efforts at stool. Agitation gene- 



106 CAUSES OF SPERMATORRHOEA. 

rally followed the evacuation of any fasces. The venereal impulse was nearly 
lost, erections occurred seldom, and were incomplete, and coitus was im- 
possible, except under very, extraordinary circumstances, and very rarely. 
The patient's digestion became difficult; flatus accumulated in the intes- 
tines, distended his abdomen, and caused pain in his epigastric and hypo- 
chondriac regions ; his skin became habitually dry and harsh. He wished to 
take exercise to favour cutaneous transpiration, and was in a continued state 
of agitation as soon as he remained still for a few minutes ; he was easily af- 
fected by cold, and his temper became very irritable. 

The suspensory bandage he wore inconvenienced him, and he left it off 
before taking a long walk. Shortly after his return, a considerable swelling 
came on in the left testicle, to disperse which leeches were applied five times 
unsuccessfully. 

About this time bichloride of mercury was administered in solution for 
the treatment of some supposed venereal vegetations around the margin of 
the anus, but which, in reality, were only contracted hemorrhoids. The dif- 
ferent means pursued increased, to a great degree, the patient's weakness of 
the legs and digestive disorder. 

When Captain V came to the hospital of St. Eloi, I was struck by 

the pallidity of his countenance, and the flaccidity of all his tissues. His 
form was rounded, with the cellular tissue very abundant and slightly infil- 
trated with serum, especially in his legs j his skin was white, thin, transpa- 
rent, and habitually cold; his pulse small and feeble. The tumour of the 
left testicle was evidently only a common hydrocele. 

Taking into consideration the order of appearance, and the general charac- 
ter of the symptoms, I thought that the intense and lengthened action of 
cold had produced a deep and lasting effect on the inferior portion of the 
spinal cord, as I had before seen in a few cases. Weakness seemed to me to 
be the symptom predominating, no appearance of irritation being present, 
either in the rectum or the genito-urinary organs; and I consequently de- 
cided on submitting the affected parts to the action of galvanism. 

The first sitting took place on the 11th of February. The current was 
established, during twenty minutes, between the sacrum and hypogastrium; 
and afterwards, for the same period, between the hips. The shocks were 
very weak, only sixteen drops of sulphuric acid having been added to the 
quart of water; yet, on the following day, the patient experienced less sen- 
sation of cold, less numbness in his left leg and in his genital organs, and 
less difficulty in emptying his bladder; besides which he had a stool. 

On the 12th a second sitting took place. The shocks were directed through 
the same parts, and applied during the same length of time; eighty drops of 
sulphuric acid being used on this occasion. 

On the 13th a third sitting was held, a hundred drops of acid being used. 
Stronger shocks were administered. Impressions were now more acutely 
felt, and the patient's improvement seemed progressively increasing. 

On the 14th, galvanism was again applied, a hundred and forty drops of 
sulphuric acid being added to the quart of water. The current was esta- 
blished occasionally between the loins and the perineum, and the surface of 
the hydrocele. The following day the patient had a free evacuation with- 
out enema; he experienced a feeling of power in the rectum, with less 
numbness in the lower extremities, from the pelvis as far as the knees; the 
legs and feet were in the same state as before; there was a considerable 
diminution in the size of the hydrocele; the patient's erections had becom e 



INFLUENCE OF THE KECTUM. 107 

more energetic, and he was altogether more cheerful, notwithstanding the 
fatigue caused him by the violent shocks to which he had been subjected. 
He spoke of the galvanism with pleasure, but requested two or three days' 
rest before being again subjected to its action. 

From the 15th to the 19th galvanism was not employed. No improve- 
ment took place during these days. 

From the 20th to the 24th five sittings similar to the preceding took 
place, the quantity of sulphuric acid being increased on each occasion. Af- 
ter these the bowels were opened freely every day, without straining or semi- 
nal discharge. His urine was discharged easily, in a full stream. The li- 
quid effused in the tunica vaginalis was completely absorbed. The patient's 
digestion became active; the intestinal flatulence disappeared, and the warmth 
and strength of the inferior extremities were restored. 

Shortly afterwards M. V rejoined his regiment, and resumed his du- 
ties as before. Four or five years afterwards I met with M. V , who 

had attained the rank of general. He told me that his health had not 
undergone the least alteration. 

This patient had suffered from five or six attacks of urethritis, be- 
sides a chancre, and he had undergone many energetic courses of 
anti-venereals, of which one course only would have been useless, 
and even injurious. There are, therefore, many reasons why his case 
should have been placed among those of which I have treated in the 
third chapter. On the other hand, he had suffered, for a long time, 
from hemorrhoids, which were, on one occasion, even mistaken for 
syphilitic vegetations, a mistake by no means uncommon. The 
seminal discharges were, however, due to the distention of the rec- 
tum, (as in case fourteen,) yet it seems probable that the other cir- 
cumstances had some share in bringing on the disease, because Cap- 
tain Y had suffered from obstinate constipation when at Lyons. 

These circumstances must, therefore, be taken into account; but the 
determining cause was, evidently, the extreme cold to which he was 
exposed during a whole night. This gave the disease a peculiar 
character, which is not otherwise met with. 

The first time I saw this patient I attributed the weakness of his 
lower extremities, his constipation, &c, to the seminal discharges ; 
but ©n more mature reflection respecting the sudden effect of this 
lengthened exposure to cold, I recollected other cases of the same 
nature, in which cold had left a serious impression of debility in the 
parts which had chiefly suffered. I was struck by the general and 
truly characteristic state of the constitution, by the infiltration with 
serum of the affected parts, by the temperature of the skin, &c; I 
concluded, therefore, that the pollutions arose from distention of the 
rectum, and that this was kept up by a kind of torpidity which the 
cold had produced in the nerves arising from the inferior portion of 
the spinal cord. This chain of reasoning led me to think of gal- 
vanism — a remedy, from the use of which, I had seen benefit arise 
in analogous cases. 

The result proved this indication to be the right one, and the cure 
was even more rapid and decided than I had ventured to hope for. 



108 CAUSES OF SPERMATORRHEA. 






The hydrocele which existed in this patient seemed to have been 
caused by the repeated attacks of urethritis ; and the rapidity with 
which the effusion was absorbed under the use of galvanism, was 
very remarkable. This circumstance proves galvanism to have been 
the remedy best suited to the case. I shall relate here another case, 
illustrating the effects of cold, and which is also remarkable in other 
respects. 

CASE XXI. 

Intemperance — Lengthened exposure to cold — Chronic inflammation of the 
bladder — Involuntary seminal discharges, &c. — Cauterization — Cure. 
Relapse — Same treatment with the same result — Remarkable influence 
of the bladder on the rectum. 

G , a soldier in the 4th regiment of light infantry, much addicted to 

intemperance, enjoyed pretty good health, with the exception of two or three 
slight attacks of blennorrhagia, until the age of thirty. At this age, how- 
ever, when intoxicated and in an excessive state of perspiration, G — — ■ 
plunged into cold water as far as his middle, and afterwards allowed his 
clothes to dry on his person. 

Shortly afterwards G felt acute pain in the lumbar region, with weight 

in the hypogastrium, and a frequent desire to make water, which he passed 
with some little difficulty. Camphorated frictions on the loins, with rest, 

and an antiphlogistic regimen, gave him momentary relief; but G soon 

perceived that he was more easily fatigued than before, and especially that 
his legs daily grew weaker. He continued to perform his military duties 
during eighteen months, though with great and increasing difficulty; and at 
length he became so weak that he was obliged to apply for his discharge. 

Having returned to his native town, he commenced business as a tailor, 
and he had not long followed this employment when he perceived that he 
passed semen frequently, without either erection or pleasure. These dis- 
charges grew more and more frequent, and were accompanied by an irresisti- 
ble and frequent call to empty the rectum ; his urine was passed with much 
difficulty, requiring efforts which were very fatiguing. 

During the years 1830 and 1831, the weakness of his legs continued to 
increase. His digestion was difficult, and his genital organs were much re- 
laxed. 

In March, 1832, after a fit of intemperance, G was seized by a com- 
plete retention of urine, for which baths, fomentations, and emollient drinks 
were prescribed. This state gave place to one of strangury, soon followed 
by incontinence of urine. 

In May, 1832, artificial sulphuretted baths were employed without bene- 
fit, and in September, the baths of Balaruc, with no better result. 

On the 4th of October, G was admitted into the hospital of St. Eloi. 

Two moxas were applied to his loins, and shortly afterwards four issues lower 
down. 

On the 1st of November, G took some soup and wine, and the fol- 
lowing day acute irritation of the neck of the bladder came on, for which 
he was treated by leeches to the hypogastrium, baths and camphorated 
drinks. The pain diminished, but the passage of urine was preceded by a 
discharge of milky fluid. 



INFLUENCE OF THE RECTUM. 109 

At this time the patient first came under my care. I found him in the 
following state. He was thirty-five years of age, of moderate stature; his 
skin white, face pale, hair black and scanty, voice feeble and rather husky, 
digestion difficult, especially after the use of animal food j he was frequently 
compelled to go to stool, the presence of a little faecal matter in the rectum 
inducing a painful feeling, which caused its involuntary expulsion. He 
passed urine every ten minutes or quarter of an hour, without being aware 
of its escape, and the fluid contained an abundant deposit of a greenish white 
colour, which appeared flocculent. The urine decomposed very rapidly. He 
had no venereal desires, and not the least appearance of erections. His lower 
extremities were so weak as scarcely to support the weight of his body. His 
legs were the constant seat of osseous pains, and his feet were habitually 
cold. He seemed indifferent to every thing. 

On the 14th of November I performed a slight cauterization of the neck 
of the bladder, and of the surface of the prostate. The patient experienced 
little pain during the operation; there was no discharge of blood and but 
little burning afterwards. 

On the 22 d the urinary deposit had considerably decreased in quantity. 

By the 26th the deposit had entirely disappeared. 

On the 28th the urine appeared quite limpid, and the patient was able to 
retain it for half an hour, but it was still passed involuntarily. The faeces 
were not passed so often, and the lower extremities were a little stronger. 

On the 29th I performed a second and more complete cauterization of the 
same parts. The pain was considerable, and followed by burning. Bloody 
urine was afterwards passed very frequently. On the 4th of December 
the patient was able to walk without the aid of crutches; his appetite and 
his spirits returned. On the following days the urine and faeces were held 
longer. 

On the 11th of December a third cauterization was practised, beginning by 
the bladder, and ending at the bulb of the urethra. 

On the 18th, the patient was able to retain his urine, which was quite 
limpid, for an hour; animal food was well digested; his erections returned; 
his legs regained their normal strength; his face acquired colour and ani- 
mation, and his spirits had returned. The fceces were retained as long as 
in health. 

On the 20th, the patient felt so well that he left the hospital; his con- 
valescence continued, and indeed seemed to make more rapid progress in 
proportion to the amount of exercise he took. 

In the month of February, 1833, Gr having occasion to take a long 

journey during very severe cold, drank a considerable quantity of wine. 
In the month of May he re-entered the hospital, in almost the same state as 
at first. I performed a fourth cauterization similar to the last, and with the 
same good effects. 

I afterwards prescribed tar-water and the use of the artificial sulphuretted 
baths, and at the end of two months all the symptoms had disappeared, and 
the patient left the hospital quite re-established. 

A lengthened exposure to cold was followed in this, as in the pre- 
vious case, by diurnal pollutions, and by almost complete paralysis 
of the lower extremities. But here all resemblance between the 
two cases ceases. 



110 CAUSES OF SPERMATORRHEA. 

In Captain V the cold had acted especially on the nerves 

■which are given off by the lower portion of the spinal cord; these 
had been affected with a loss of power, from which the rectum had 
chiefly suffered ; hence, its distention by faeces, and the consequent 
compression of the seminal vesicles. There was not the slightest 
appearance of irritation in the parts, and, for this reason, the gal- 
vanism produced such beneficial effects. In the patient G , the 

cold chiefly acted on the bladder, and the chronic cystitis resulting 
from it extended its influence successively to the seminal vesicles and 
the rectum. The extreme weakness of the lower limbs arose from 
the repeated seminal discharges, which wore the patient out. Hence 
cauterization was followed by the happiest results. I am convinced 
that in this case galvanism could not have been borne. 

It is easy to explain why, in the latter case, cold acted so directly 
on the bladder — the patient's intemperance predisposed that organ 

to disease. G was intoxicated when he went into the water ; 

afterwards, when he experienced a rapid increase of his bad symp- 
toms, he had taken wine with his soup; and still later, in the jour- 
ney during the winter, which was the cause of his relapse, he had 
drunk a considerable quantity of wine. It is, therefore, by no means 
easy to separate the effects of cold, in this case, from those of intem- 
perance, the action of which on the urinary organs is easily explained. 
When considering the effects of blennorrhagia, I reported a case in 
which cold exercised a considerable influence in the production of 
spermatorrhoea, (case fifth,) but this effect was shown by very diffe- 
rent symptoms. Strangely enough, the treatment which cured these 
three patients was quite different in each case — showing the indis- 
pensable necessity of observing numerous cases, and of examining 
minutely all their peculiarities. 

A phenomenon was present in the case of the patient G , which 

shows that the influence of the rectum on the genito-urinary organs, 
is quite equalled by that of the genito-urinary organs on the rectum. 
The mucous membrane of the intestine was, in this case, so irritable 
that the gut was unable to bear the presence of fsecal matter; imme- 
diately that the faeces reached the level of the bladder, convulsive 
contractions of the muscular coat of the rectum were excited, causing 
their immediate and involuntary expulsion. The stools were not 
liquid, or mixed with mucus, as in diarrhoea, though in consequence 
of their short stay in the rectum, they were by no means solid. 

No particular treatment was pursued for the removal of the irri- 
tation of the rectum ; it diminished after each cauterization, and dis- 
appeared at the same time as the inflammation of the bladder. The 
longer the patient was able to hold his urine the less frequent his 
stools became, and both bladder and rectum seemed to return under 
the influence of the will at the same time. 

But if the inflammation of the bladder could produce such an effect 
on the rectum, it must have acted with still greater power on the 
seminal vesicles. What then was the cause of the patient's expe- 



INFLUENCE OP THE RECTUM. Ill 

riencing constant discharges of semen, both by day and night, with- 
out erection, without pleasure, and in the midst of the most perfect 
repose as regarded venereal excitement ? A certain quantity of the 
spermatic fluid having reached the seminal vesicles, produced in them, 
by its mere presence, involuntary and irresistible spasmodic contrac- 
tions, similar to those of the bladder and rectum ; the semen was 
expelled in the same manner as the urine and the faeces, and with- 
out the characters which it would have acquired after a longer de- 
tention in the reservoirs destined for its reception. 

It is evident, then, that an intimate relationship exists between all 
these parts, and that it is necessary to connect their phenomena in 
order to obtain a correct and perfect idea of their influence. 

It must by no means be thought that this effect of the genito-uri- 
nary organs on the rectum is of rare occurrence ; it is, on the con- 
trary, habitual ; but it is seldom so strikingly shown as in the pre- 
ceding case. I have not hitherto noticed it, because I wished to 
render the subject as simple as possible ; but it is to this intimate con- 
nexion that the sensation of uneasiness and weight at the margin of 
the anus, the habitual contraction of the sphincter, and the obstinate 
constipation, which are so often observed in patients affected by sper- 
matorrhoea, must be attributed. All those on whom I have practised 
cauterization of the neck of the bladder, have experienced a sudden 
burning at the margin of the anus, and a sensation of heat in the rec- 
tum immediately after the operation ; on the following day they have 
had greater tone in the rectum, and their stools have very soon be- 
come more free. I must not, however, at present, enter into further 
details on this subject. 

CASE XXII. 

Unsuspected spermatorrhoea — Attacks of cerebral congestion — Disorder of 
the general health — Ascarides expelled from the rectum with immediate 
recovery. 

M. C . a Captain of Engineers, aged about thirty-two, nearly bald, 

very thin and pale, with sunken eyes surrounded by dark circles, a feeble, 
shrill voice, and a timid, embarrassed appearance, consulted me respecting 
his health on several occasions : I never attached much importance to his 
complaints, but always attributed them to the melancholy bias of his cha- 
racter. In 1824, however, his digestion became disordered in an alarming 
manner, and was always accompanied by the disengagement of much fla- 
tus; even the ingestion of soup into the stomach was followed by oppres- 
sion in the epigastric region, and difficulty of respiration, which was espe- 
cially felt in the situation of the oesophagus, and terminated in the pharynx. 
This sensation diminished considerably as soon as the patient was able to 
pass flatus. He felt himself overcome by a sense of general debilit}^, and 
especially experienced a feeling of weakness in his legs, which contrasted 
strikingly with his continual desire for motion, and his custom of taking 
long walks. He suffered from frequent attacks of giddiness, with conges- 
tion in his head, especially when he stooped, or read, even for a few mi- 



112 CAUSES OF SPERMATORRHEA. 

nutes, and he consequently thought himself threatened by an attack of apo- 
plexy. His usual spareness of habit had increased; his testicles had dimi- 
nished sensibly in size, and his genital organs always felt cold. His pulse 
was weak and soft; his tongue pale and moist, and pressure on the epigas- 
trium did not give him the least pain. I could not participate in this patient's 
fears respecting the probability of an attack of apoplexy, or the existence of 
gastritis, for I attributed all his symptoms to excessive discharges of semen, 
although he would not admit the correctness of this opinion. 

He had abstained from coitus during a long time, from the fear of injuring 
his health, and expressed a horror of masturbation; he was not subject to 
nocturnal emissions, and he had never noticed any discharge of semen when 
passing urine or at stool. I sent him, for change of air during the heat of 
the summer, to Vigan in the Cevennes, requesting him at the same time to 
watch himself carefully while at stool, and to send me an account of the ap- 
pearance of his urine. 

A few days after his arrival at Yigan he sent me word that after each 
stool he had a discharge of thick, whitish,'slightly unctuous matter, of a very 
weak spermatic odour, and which stained his linen a pale yellow. This 
discharge was especially abundant whenever his efforts at stool were very 
violent. It was not, however, during the actual passage of faecal matter 
that the discharges of semen occurred, but shortly afterwards ; and he ex- 
perienced at the same time a sense of weight in the rectum, and a spasmodic 
contraction accompanied by itching and heat. The symptoms were then, 
as I suspected, really due to excessive spermatic discharges. Yet I did not 
attach sufficient importance to the singular circumstances which accompa- 
nied these discharges, and I was satisfied with prescribing cool injections, 
cold lotions, and vegetable and milk diet, with the intention of relieving the 
constipation, and of giving tone to the genital organs. These means pro- 
duced no remarkable change in the seminal discharges ; after a time I re- 
ceived another long letter, which was full of minute and uninteresting de- 
tails; on the back, however, the patient had written a postscript, stating 
that in one of his stools he had passed a number of little worms, and that he 
frequently felt an itching in the rectum, which he attributed to a herpetic 
affection. A slight discharge occurred from the rectum, and the faeces were 
mixed with a good deal of purulent mucus. The parts surrounding the 
anus were gorged. This state had been present from 1818, and had first 
appeared after a violent intestinal inflammation, accompanied with colic and 
tenesmus, which latter reappeared in 1822. The cause of the spermator- 
rhoea, now, was evident, and I also understood how it was that the seminal 
discharge did not take place exactly at the same time as the passage of the 
faeces, but a little after; these discharges were not produced by mechanical 
compression arising from such passage, but they were the result of a state 
of irritation produced by the presence of worms; the sensation of pressure, 
the spasmodic contraction, the itching, and the heat, which were felt in the 
rectum, proved this. 

The patient took, fasting, on three successive mornings, four grains of 
calomel, and during the day three or four glasses of decoction of Corsican 
moss, and a tepid enema, followed by a cold one; he once took a small 
enema of warm milk, and soon after a second, composed of a strong decoc- 
tion of garlic. At the end of three days, perceiving no more ascarides in 
his stools, he left off treatment for a week, after which he took, at bed time, 
four grains of calomel, followed by six drachms of sulphate of magnesia, the 



INFLUENCE OF THE RECTUM. 113 

next morning. Four copious stools were obtained, which presented no ap- 
pearance worthy of note. Soon after this, Captain C wrote to me 

stating that his strength had returned; that his stomach performed all its 
functions properly; that the spermatic discharges had ceased, together with 
the discharge from the anus, and the itching, &c, with which he had pre- 
viously been tormented. 

The ascarides reappeared every year, however, at a stated period, and 
sometimes even twice a year, but the patient was able to treat himself, and 
immediately that any symptoms announced their presence, he got rid of them 
in two or three days — his health never becoming disordered. 



CASE XXIII. 

Masturbation at nine years of age — Constant nocturnal emissions — Ascarides 
— Cure in eight days. 

Henry B , a Sergeant of Engineers, at the age of nine, was addicted 

to the vice of masturbation, which he continued to practise up to the age of 
fifteen, when he corrected himself. From this time he experienced frequent 
nocturnal pollutions. Loss of flesh followed, with pains in the chest and a 
fixed pain in the middle of the back. The whole nervous system was dis- 
ordered, and the patient's eyes were injected and surrounded by dark circles. 
After the occurrence of a nocturnal emission, the patient often noticed that 
he had pricking sensations, as though he had been stung by ants, with acute 
pain in the lower part of his abdomen, and in his loins. 

He was completely overcome by fatigue in the morning, and felt, when 
he rose from bed, as though his legs and arms had been bruised ; he com- 
plained also of oppression at his chest, and a sense of suffocation. He felt 
buzzing in his ears in the evening ; he lost his memory, was unable to at- 
tend to his affairs, and performed his military duty with much difficulty. This 
state had continued for several years, and became daily more serious. 
Various modes of treatment had been employed by different medical men 
whom the patient had consulted; among other remedies used may be 
named quinine, oxide of iron, ferruginous water mixed with wine of Bor- 
deaux, lime-water in milk, and Hoffman's anodyne at night. Biver-bathing 
and cold enemata had also been tried, and the patient had applied, during 
the coldest season, snow and ice over his kidneys and genital organs. No 
advantage whatever was derived from all these means, and sal-ammoniac dis- 
solved in water, to form a cold lotion, only irritated the skin of the penis and 
scrotum. 

Henry B was twenty years of age when he first consulted me ; his 

face appeared coloured and healthy, and his form announced health and 
vigour. It was therefore difficult to guess the cause of the deep melancholy 
which his features showed. After much questioning, I at length learnt that 
he had been subject to worms from his childhood — that he passed them 
every time he went to stool, and that his faeces were sometimes quite 
covered with them. From the description he gave me, I was convinced 
that they consisted of oxyures, with perhaps a few triclioccphaJi. I pre- 
scribed for him four grains of calomel night and morning, with half a 
drachm of mercurial ointment to be introduced into the rectum night and 
morning, and enemata composed of potentilla anserina in decoction. Eight 
8 



114 CAUSES OF SPERMATORRHEA. 

days afterwards he told me that his pollutions had ceased, and that his health 
was quite restored. 

CASE XXIV. 

Hypochondriasis — Impotence — Attacks of cerebral congestion — Ascarides — 
Cure within eight days. 

A , a gardener of large and well formed frame, and dark complexion, 

two years married, perceived, seven or eight months after marriage, that 
he lost by degrees his virile power; that his appetite at the same time 
became capricious, and his digestion difficult and accompanied with pain 
in the epigastrium, the development of flatus, and frequent attacks of 
vomiting. 

Pills containing cynoglossus, sedatives, and demulcents of all kinds, had 
been prescribed for this patient by a distinguished practitioner of Montpel- 
lier, in order to relieve the irritation of his digestive organs ; but his general 
weakness, and that of the genital organs in particular, increased daily. A 
feeling of lassitude constantly came over him, he was habitually sleepy, and 
had frequent attacks of vertigo. These symptoms led other practitioners 
whom he consulted to fear the occurrence of apoplexy, and consequently 
venesection was prescribed : but the patient, notwithstanding his uneasi- 
ness, refused to be bled, saying that he was convinced he had no blood to 
lose. In 1833, A consulted one of my pupils, who, after long ques- 
tioning, learnt that he suffered from obstinate costiveness, with troublesome 
itching in the rectum, and that he frequently passed a number of oxyures 
with his faeces. Believing that these oxyures were the cause of seminal dis- 
charges which the patient had not discovered, an infusion of mentha viridis 
was ordered for him, with aromatic enemata, and afterwards enemata of cold 
salt-water, sufficiently copious to distend the gut and to be expelled with 
some violence. These injections caused the expulsion of a large number of 
entozoa. 

The patient's digestive disorder ceased almost immediately; his erections 
soon returned, and coitus took place a few days afterwards. He soon re- 
covered his strength ; his spirits resumed their wonted gaiety, and he recom- 
menced his work with pleasure. This change was the result of only eight 
days' treatment. 

CASE XXV. 

Nocturnal pollutions, resisting all modes of treatment during six years — 
Great physical and moral depression — Expulsion of ascarides with com- 
plete relief 

M. D , the son of healthy parents, at the age of eleven, contracted, of 

his own accord, the habit of masturbation ; but he soon discovered its per- 
nicious effects, and corrected himself : his strength returned, and up to the 
age of fourteen he continued in perfect health. At this period, after reading 
an erotic book, he relapsed into his former habits. He also formed a con- 
nexion with a female, who excited his passions without gratifying them. 
These sources of excitement so enervated him, that palpitation of the heart, 
and tremors in his limbs, supervened. 

Up to this period M. D had never had an involuntary seminal emis- 



INFLUENCE OF THE RECTUM. 115 

sion, and he still retained sufficient power over himself, only to practise 
masturbation once a week. The irritation he experienced in the genital 
organs was so great that he was often forced to plunge them into cold water 
for its relief. He was stout and tall, and his health was robust. 

On the 25th of October, 1815, on waking in the morning, M. D 

found that he had experienced a copious seminal emission unconsciously 
while asleep. On every one of the eight following nights he had several 
involuntary emissions. These discharges produced a remarkable state of 
weakness, and he lost flesh visibly; still he hoped that the discharges would 
cea%e spontaneously, and false delicacy prevented him from mentioning his 
state. Absorbed in the consideration of his own condition, M. D — — now 
withdrew himself from his companions, and occupied himself in devising 
means for the relief of the discharges. He attempted numerous ingenious 
contrivances to prevent the penis from becoming erect during sleep, but none 
of them succeeded ; the disorder of his health continued to increase, until the 
year 1820, when his condition was deplorable, and he came to Montpellier 
to place himself under my care. From his account of the sufferings he had 
endured, I at first thought that the involuntary emissions from which he had 
suffered, arose from a preternatural sensibility of the genital organs, increased 
by their premature use. Before commencing any plan of treatment, however, 

I caused M. D to draw up a history of his case, in order that I might 

have all the facts before me at one view. While reading this history, my 
attention was arrested by the mention of numerous small worms, which were 
passed with the fasces, and which were looked on by the unfortunate patient 
as a sign of speedy dissolution. I examined the anus, and was unable to 
discover the eruption which he mentioned in his memoir, as giving rise to 
acute irritation in that neighbourhood, besides which, this eruption would 
not have produced the itching of the nose of which he also complained. I 
suspected, therefore, that the involuntary emissions might be kept up by 
irritation from ascarides, and I drew the patient's attention to the circum- 
stance. He told me, immediately, that he passed them habitually in his 
stools; and that frequently, from the violent nature of the itching, he had 
been compelled to scratch until blood flowed, and even to introduce his finger 
nail within the margin of the anus, when on withdrawing it, he had removed 
a living oxyuris. About ten o'clock in the evening the oxyuris especially 
tormented him by descending into the lower portion of the rectum, and even 
within the contracted sphincter. He had besides, a constant acid taste in 
his mouth, and he passed a large quantity of saliva on his pillow, during the 
night. 

Of all the means prescribed for this patient, the administration of cold 
enemata, and the exhibition of calomel, were the most efficacious. The 
first injections were employed at a temperature of from 18° to 20° of 
Reaumur, 1 and they were afterwards used at 15° and even at 12° of the 
same scale. 3 Experience soon taught the patient that he received most 
benefit from their administration about ten o'clock in the evening, at the 
time when the ascarides descended near the anus, of which he became 
aware, by the increased itching excited. He found also that in order to 
obtain the utmost benefit from the injections, it was necessary to throw a 



Between 70° and 80° of Fahrenheit. 
About 59° and 68° of Fahrenheit's scale. 



116 CAUSES OF SPERMATORRHOEA. 

large quantity of water into the intestine, as high as possible, and after- 
wards to pass it suddenly so as to expel the ascarides inhabiting the upper 
part of the intestine, at the moment when they were benumbed. By these 
means large quantities of the entozoa were passed on several successive days; 
after their expulsion the involuntary emissions diminished rapidly and per- 
manently, and all the accidents arising from them disappeared; the patient's 
strength and embonpoint, especially, returned very quickly. The involuntary 
emissions, however, only ceased entirely under the influence of a natural 
exercise of the organs, with the use of cold bathing, and gymnastic exercise. 
The patient had previously been obliged, on two occasions, to give up the 
use of the cold bath — once during the heat of summer, because he was unable 
to obtain a proper reaction on quitting the water ; yet immediately that his 
system had recovered a little strength, he found himself much benefited by 
cold bathing; indeed, after the expulsion of the ascarides, it produced more 
benefit than any other means employed, and he even commenced the use of 
the cold plunge during the winter, with considerable advantage. 

Walking exercise was also very useful, and this perhaps it was that 

induced M. D- , after having completed his medical education at Mont- 

pellier, to turn his attention to the study of natural history. He has since 
undertaken long and dangerous travels in the service of science, and the 
works he has published bear the stamp of an observing mind, and a high 
range of thought. His labours have always been favourably received by the 

academy of sciences. M. D 's health has been completely re-established 

twenty-five years. 

The history sent to me by M. D was full of interest ; it showed 

a kind of fatality pursuing him, although he struggled with courage 
and perseverance against troubles which he had not deserved. It is 
necessary to have undergone such sufferings, and to write under their 
immediate influence, in order to relate all their circumstances with 
correctness. An uninterested observer would be unable to do justice 

to such a recital. How many such persons as M. D do we not 

meet with, constantly exposed to the relentless animadversions of 
society, when they ought to be regarded with pity, and to be relieved 
from their sufferings by the healing hand of the physician ! 

Two of the patients, whose cases I have just related, (cases twenty- 
three and twenty-four) who suffered in infancy from ascarides, were 
addicted to masturbation, even before the age of puberty. They 
afterwards reproached themselves bitterly, and attributed all their 
misfortunes to this fatal habit. But it appears to me that in order 
to induce such a habit spontaneously, at so early an age, long before 
the full development of the genital organs, a degree of abnormal 
irritation must be present in them. 

The irritation caused by stone in the bladder often excites, in 
male infants, premature erections, and pain referred to the fossa 
navicularis ; this they relieve by elongating the penis, so that in such 
patients, as is well known, the prepuce is of unnatural length. These 
manoeuvres naturally lead them to habits for which they ought not, 
under such circumstances, to be held morally responsible. 



INFLUENCE OF THE RECTUM. 117 

The irritation produced by ascarides in the rectum constantly ex- 
cites the same phenomena, and I have frequently seen children two 
or three years of age affected with priapism, which could be referred 
to no other cause. This circumstance is so common, that it has been 
frequently mentioned to me by nurses, who even employ a popular 
remedy to relieve it, showing, at least, that the influence of the asca- 
rides is well known. Nurses introduce a suppository of lard into the 
rectum, under the impression that the ascarides come there in search 
of food, and that they will be able to remove them together with the 
lard, on withdrawing it. The cause of these premature erections 
cannot, therefore, be doubted. 

Such children must, in consequence of the irritation of the parts, 
possess an irresistible tendency to handle them, just as they have, 
under the same circumstances, to scratch and rub the nose ; and the 
sensation resulting from the friction of the genital organs being very 
acute, is likely enough to form the basis of a more mischievous habit. 
When, on reaching puberty, reason assumes its empire, the patients 
often acquire sufficient command over themselves to renounce these 
fatal practices, and they then suffer from involuntary emissions 
arising from the same cause that excited the masturbation ; that is to 
say, from the irritation of the genital organs by the worms inhabit- 
ing the rectum. 

Ascarides produce nearly the same effects in the female ; I have 
seen many little girls of tender age, who were tormented by irresistible 
itching of the pudendum, and profuse leucorrhoea, often accompanied 
with redness and excoriation of the clitoris and labia minora, all 
arising from the same source of irritation. 

The involuntary emissions of semen which accompany defecation 
in those patients who are affected with ascarides, cannot be attributed 
to mechanical compression of the seminal vesicles, for costiveness is 
not present, nor could constipation account for the nocturnal emis- 
sions ; it appears to me that the titillation constantly exercised on the 
rectum and margin of the anus, by the ascarides, extends its influ- 
ence to the genital organs, and excites spasmodic contractions of the 
seminal vesicles. 

CASE XXVI. 

Tlie habit of masturbation contracted spontaneously at the age of fifteen, 
and continued until the age of tioenty — Nocturnal and diurnal pollu- 
tions — Increasing disorder of the health until the age of tioenty -nine — 
Frequent and prolonged erections — Pain at the margin of the anus, dbc. — 
Cauterization performed without benefit — The expulsion of ascarides fol- 
lowed by rapid recovery. 

M. R , a student of medicine, enjoyed good health in his childhood, 

but about the age of fifteen was tormented by frequent and prolonged 
erections. One evening, for the relief of the itching, of which the extremity 
of the penis was the seat, he rubbed the organ violently between his hands. 
This led to the establishment of masturbation as a habit or rather as a pas- 



118 CAUSES OF SPERMATORRHEA. 

sion, the patient practising it sometimes as often as eight or ten times a day. 
His health by degrees became so altered that one of his friends suspected 
his practices, and told him the danger of his situation. By degrees he 
corrected himself, though not entirely, before he had attained his twen- 
tieth year. On his renouncing masturbation, nocturnal emissions super- 
vened, and often occurred two or three times a night. They dimi- 
nished after a time, but without ceasing entirely, and seminal emissions 
during defecation and the emission of urine were added to them. Thus his 
health became daily more and more disordered for nine years, notwithstand- 
ing absolute continence, a severe regimen, and the use of sedatives, tonics, 
and anti-spasmodics. At length he grew incapable of any mental exertion. 
In 1837, he came to Montpellier, at the age of twenty-nine, in the following 
condition: — Extreme emaciation; face pale; appearance stupid and con- 
fused ; intellect dull ; reasoning powers much affected, the patient being in- 
capable of connecting two ideas on the most simple topic of conversation ; 
loss of memory ; constant headache referred to the forehead and temples, and 
increased by any mental excitement, being then accompanied by nervous 
tremors, and an almost idiotic state ; sleep broken and unrefreshing ; con- 
stant sighing; frequent attacks of congestion of the head, especially at night; 
violent noise in the ears resembling the sound of a waterfall; vertigo ; stun- 
ning sensations giving rise to a constant fear of apoplexy ; timidity carried 
to a ridiculous extent ; panics of fear even during the day ; character 
gloomy, taciturn, restless, and irritable ; horror of the least noise, and of all 
society ; irresistible restlessness ; great weakness ; abundant sweats after 
very slight exertion; almost constant coryza; frequent dry and hard cough; 
pains in the base of the chest, the region of the heart, and along the spinal 
column ; appetite voracious ; dragging at the pit of the stomach ; difficult 
digestion, accompanied with the development of flatus; grinding of the 
teeth during sleep; burning at the point of the tongue ; darting pains in the 
bowels, especially in the rectum; obstinate constipation alternating with 
violent attacks of diarrhoea; stools containing much mucus, and sometimes 
streaked with blood; periodical pains at the margin of the anus, in the pe- 
rineum, penis, and testicles ; urine passed in large quantities, and very fre- 
quently, always throwing down a whitish, thick, and very abundant deposit, 
involuntary emissions during defecation, both when constipated and relaxed; 
frequent and prolonged erections by day as well as by night ; with constant 
presence of erotic ideas. 

On sounding this patient, I found the urethra very sensitive, especially 
towards the neck of the bladder, and I consequently thought that the noc- 
turnal and diurnal pollutions were kept up by a state of irritation arising 
from masturbation. I therefore proposed cauterization. This was performed 
on the following day, and produced the usual immediate effects, but its 
curative effects did not take place as I had anticipated. I then directed the 
patient to notice his fasces, and a few days afterwards he told me that he 
had observed numerous little worms passed in his stools. I now ordered 
enemata of cold water, and salt and water, which, however, produced only 
a momentary effect — probably because the ascarides inhabited the upper 
part of the intestine. A few doses of calomel, however, caused them to 
disappear without returning ; and from this moment the involuntary diurnal 
emissions ceased entirely, the nocturnal emissions became more and more 

rare, and the patient's re-establishment progressed very rapidly. M. R 

returned to his studies with ardour, and long afterwards all functions were 
perfectly well performed. 



INFLUENCE OF THE RECTUM. 119 

It appears evident that the irritation caused by the ascarides in 
the rectum, first led this patient to practise masturbation, and after- 
wards kept up involuntary seminal discharges. I did not discover 
this at first, because the history of his case, sent me by the patient, 
was so long, and was characterized by such disorder and want of 
clearness, that I was unable to arrive at any satisfactory conclusions 
from such a chaos ; his answers were still more vague and uncon- 
nected, so that my attention had been chiefly attracted to the state 
of his intellect, and the abuses he had committed. But after seeing 
the little success of cauterization, and again reading his notes, I paid 
more attention to the circumstances attending the commencement of 
his practising masturbation, and I noticed several symptoms to which 
I had not before attached importance, such as grinding of the teeth 
during sleep ; burning pain in the point of the tongue ; pain in the 
rectum, and at the margin of the anus ; the stools always containing 
mucus, and sometimes being streaked with blood ; and especially 
the frequency and duration of the erections, and the constant pre- 
sence of erotic ideas. 

When costiveness is present the stools rarely contain any quantity 
of mucus ; its presence alone, therefore, in such a case, would indi- 
cate that the rectum is irritated by ascarides. But a still more cha- 
racteristic point is, the long duration of the erections. When invo- 
luntary spermatic discharges are induced by any cause except this, 
the erections diminish in proportion as the disease advances, first 
becoming incomplete, and afterwards disappearing entirely. When, 
therefore, energetic and obstinate erections continue, in spite of the 
great wastings of the body produced by them, they must be kept up 
by some other stimulus to the organs than the natural one, and I be- 
lieve irritation by ascarides to be the only cause capable of producing 
this effect. This, on the other hand, agrees perfectly with what I 
have already stated concerning their influence on the genital organs. 

CASE XXVII. 

Masturbation at the age of fifteen — Serious disorder — The application of 
a blister followed by involuntary nocturnal emissions — Cauterization, 
douches, &c, unsuccessful — Expulsion of ascarides, followed by a rapid 
recovery. 

Simon G , a vine dresser, short, stoutly formed, and of sanguineous 

temperament, reached the age of fifteen without suffering from any disease. 
At this period, while watching goats with other children, he was led by their 
example to practise masturbation. At first, no emission took place, but at 
the end of about a month, his manoeuvres caused the discharge of a few 
drops of blood, with burning at the root of the penis, and pain in the testi- 
cles. Soon after, a general lassitude supervened, with a sense of fatigue in 
all his body, and cold sweats. No semen was discharged for a long time, 
and during the first five months that seminal emissions occurred, the dis- 
charge was very fluid, and produced very little sensation. 



120 CAUSES OF SPERMATORRHEA. 

After Simon Gr had followed these mal-practices for a few weeks, he 

experienced darting pain in the stomach ; flushes of heat in the face, and 
chilliness about the feet. At the age of sixteen, pain and creeping sensa- 
tions along the spinal column were added to these symptoms; and still later, 
severe cramps in the limbs, and weakness of the lower extremities. At the 
age of seventeen, the patient was much troubled with palpitations of the 
heart, especially after masturbation. His stools were costive, passed with 
difficulty and pain, and often streaked with blood. These symptoms were 
followed by lassitude, pains in the shoulders, difficult digestion, accompanied 
with acidity and development of flatus, with increased palpitations; his sleep 
was no longer sound and refreshing. 

At the age of eighteen, congestions of the head supervened, with burning 
and redness of the face, occurring as often as five or six times a day; the 
patient suffered from heartburn, and difficult respiration, with a sensation as 
though his throat were compressed. 

At the age of nineteen, he carried masturbation so far as to produce san- 
guineous emissions. His debility now became so great, that he was unable 
to follow his occupation, or even to walk a short distance without frequently 
resting. The use of wine, even in small quantities, always increased his 
debility, and his other disorders. At this time leeches were applied to the 
anus; blisters to the epigastrium, nape of the neck and shoulders; and re- 
frigerant drinks were ordered. Shortly after the application of the blisters, 
nocturnal emissions, preceded by erotic dreams, occurred for the first time, 
and were followed by cramps in the legs, and griping pain in the stomach. 
Eroni this period the nocturnal emissions occurred nearly every night, and 
frequently several times a night. 

At this time his disorder increased so much, that a medical man was con- 
sulted. Gr confessed the cause of his illness; promised to correct him- 
self, and kept his word. The treatment consisted of leeches to the back of 
the neck; syrup of quinine; about two hundred aromatic baths; friction 
with camphor over the back of the neck, the spine, and limbs; sleeping on 
a very hard bed, &c. 

After having employed these various means during eighteen months, with- 
out receiving the least benefit, Gr left off all treatment, and at length 

came to Montpellier, and was admitted into the hospital St. Eloi, on the 14th 
of February. 

Gr was then twenty-two years of age, and his external appearance 

announced strength and health; his embonpoint was considerable, and his 
face full and red; yet he was sad, weak, and without courage, in fact his 
state had not improved in the least during the two years that he had ceased 
to practise masturbation; and his nocturnal emissions had ceased for six 
days at a time, or longer, without his becoming any better. This last cir- 
cumstance made me suspect that he suffered, at the same time, from diurnal 
pollutions. His stools were often very constipated; and the hardened faeces, 
accumulating in the rectum, were discharged with difficulty and pain — 
semen always escaping, at the same time, in greater or less quantity. The 
desire of micturition was frequent and sudden, and it generally aroused 
the patient four or five times during the night; the last drops of urine were 
thick, viscid, and followed by a still more consistent matter, which remained 
at the orifice of the glans. The urine itself contained an abundant thick, 
whitish, and flocculent deposit, like that thrown down by a strong decoc- 
tion of pearl barley. The mucous membrane of the urethra was very 



INFLUENCE OF THE RECTUM. 121 

sensitive, especially towards the prostate; and the passage of a catheter was 
arrested by spasmodic contraction of the neck of the bladder. 

After observing these symptoms for seven or eight days, on the 22d of 
February I performed cauterization from the neck of the bladder to the 
membranous portion of the urethra. The following night two very painful 
nocturnal emissions occurred; two more took place on the third night, and 
they were renewed every second or third night, notwithstanding the use 
of baths, enemata, cold douches, camphorated emulsions, and morphia. The 
urine was little altered in appearance, and there was little, if any, improve- 
ment in the general symptoms. The sleep continued broken and unrefreshing. 
The patient was always disturbed by painful erections, and an uncomfortable 
itching at the orifice of the urethra. At length, one day he informed me 
that he had observed in his faeces numerous little worms about six lines 
long, and pointed at both ends. It was plain, therefore, that ascarides were 
present in the rectum, and that before benefit could be derived from any 
other means, it would be necessary to expel them. 1 



1 The effects produced in the following remarkable case, which has recently come 
under my notice, appear to me to have been due, in a great measure, to the irritation 
excited by ascarides ; and the circumstance so well illustrates the connexion between 
the rectum and genito-urinary apparatus, that I am induced to break through my 
original intention, of not adding any of the results of my own experience to M. Lalle- 
mand's very full and complete treatise, and to publish the case as it is contained in 
my note book. Mr. M , aged about thirty, of florid complexion, two years mar- 
ried, called on me in a state of great mental excitement and distress, in the beginning 
of March, 1846. He told me that about a week before, while getting up one morning, 
he had observed a slight gluey discharge between the lips of the urethra, that he had 
taken no notice of the circumstance, but had employed himself about his affairs as usual. 
He was in perfectly good health, and in fact had forgotten the occurrence, until on the 
third morning it was recalled to his recollection by the appearance of a considerable 
discharge in the same situation, accompanied with pain during micturition. As he 
had a slight cold at the time, he attributed these symptoms to its effects, and contented 
himself, for that day, with remaining within doors, and restricting his diet to vegeta- 
bles and slops. Still, the pain during micturition continued, the discharge increased 
in quantity, and became thicker and greenish. He now became a prey to the most 
harassing suspicions, though he still was unwilling to seek advice, in the hope that 
the discharge would cease spontaneously, as it had arisen. In this state the patient 
continued, until the morning of the 10th of March, by which time he was wrought to 
the highest pitch of mental excitement by the thoughts that constantly obtruded 
themselves on his mind. 

He told me that he had suffered from three attacks of blennorrhagia : — the first, a 
very severe one, about the age of nineteen, — the last, about twenty-five. He had never 
had any syphilitic affection. With the first attack of blennorrhagia he had been con- 
fined to his bed nearly a week, from irritability of the bladder attended with strangury, 
&c, and that he had frequently, since that time, suffered from slight attacks of vesical 
irritation, after exposure to wet or cold, or after very slight excess at table. He could 
not account for the present symptoms in any way, unless by referring them to a very 
slight cold which had entirely passed off, or by giving credit to suspicions which would 
entirely overthrow his domestic happiness, and for which he had, otherwise, not the 
most remote cause. 

From the state of my patient's feelings, I saw that something must be immediately 
done, to remove suspense ; I therefore assured him that cases of urethral discharge, 
from slight excitement, were not uncommon, especially in persons like himself, who 
had repeatedly suffered from blennorrhagia, and were predisposed to irritability of the 
organs. When he became a little more composed, on examining the genital organs, I 
found a viscid greenish discharge from the urethra, not exactly resembling the ordinary 
thick, dark, discharge of blennorrhagia, but containing a considerable quantity of 
mucus, and of a glairy consistence. The orifice of the urethra was neither swollen 



]22 CAUSES OF SPERMATORRHEA. 

I accordingly ordered four, six, and eight-grain doses of calomel, to be 
followed by injections for this purpose. The patient's condition immediately 
began to improve rapidly; his nocturnal emissions ceased; his urine became 
transparent; the local and general symptoms disappeared; and he left the 
hospital on the 1st of April quite re-established in health. 

Masturbation, excited by bad example, produced from the first a 
serious disorder in this patient's health. On two occasions the prac- 



nor red, and on inquiry I found that although the patient suffered from painful erec- 
tions, they by no means resembled the chordee from which he had suffered on previous 
occasions, but that the pain was rather situated in the prostatic and membranous 
portions of the urethra. He suffered much from strangury, and his urine was highly 
acid. The chief pain that occurred during its emission was felt in the perineum, and 
the scalding near the orifice of the urethra, which usually attends blennorrhagia, was 
scarcely sufficient to attract his notice. Under these circumstances, believing the case 
to be simply irritation of the neck of the bladder from cold, I considered that I might 
at once relieve his anxiety as to the nature of the discharge, by positively assuring 
him that it was not venereal, and that with care he would probably be well in a few 
days. 

I ordered for him a warm hip bath, and some bicarbonate of potass in gum-water, 
with tincture of henbane, and requested him to abstain from all stimulants, and to be 
careful to avoid exposure to cold or damp. The following day he called on me, con- 
siderably relieved from his strangury, and with his urine in a much more healthy 
state ; but the discharge continued as severe as before, and there was still considerable 
pain in making water. A continuance of the same remedies was prescribed, and 
patience enjoined. The two following days the patient did not call, and I had begun 
to suppose that he was quite recovered, when on the 15th he returned, almost as much 
excited as at first. He was convinced, he said, that his disease was more serious than 
I had led him to believe, and that there was only one way of accounting for it ; he 
was a ruined man, &c. After he had become a little calm, he stated to me that the 
irritation had returned, that the discharge was more abundant, and he was convinced, 
that had it been simple irritation of the neck of the bladder, all these symptoms would 
have ceased long before. He complained of a burning heat, and a sense of weight in 
the rectum, which induced me to request an examination of the prostate. When pro- 
ceeding to do so, I observed the parts in the neighbourhood of the anus red, hot, and 
excoriated, and on questioning, he told me that he had long suffered severely from 
itching in the neighbourhood, but that he had omitted to mention it to me, as he had 
not considered it of any importance, believing it to arise from little worms which he 
often passed in his stools. This fact threw a new light on the case, and I began to 
suspect that the irritation produced by ascarides was the cause of the vesical irritation 
and urethral discharge. On being questioned, he recollected that the strangury always 
increased towards night, when he generally suffered most from the itching of the 
rectum, and that he had felt itching and severe burning pain in the neighbourhood of 
the rectum, long before the occurrence of the present attack of irritation, and before 
the appearance of the urethral discharge. I now ordered, in addition to his former 
medicines, a dose of calomel at bed time, to be followed by a smart purgative in the 
morning, and a copious injection of salt and water to be thrown into the rectum as 
rapidly as possible, whenever he found the irritation and itching very troublesome. 

The following day the patient called to let me know that he was much improved. 
The purgative, and one injection which he had used, had brought away a perfect nest 
of ascarides. The injection was repeated on the second night, and a few entozoa were 

discharged. On the 22d of March Mr. D called to say that the urethral discharge, 

scalding and vesical irritation, had entirely ceased, and that he no longer suffered from 
the intolerable itching that had previously almost constantly annoyed him ; I advised 
him to use an enema occasionally, for a month or two, to prevent a return of his 
tormentors; this he has done, and the last time I saw him, some months after his 
recovery, he was in excellent health and spirits, and able to enjoy all the comfort of 
domestic felicity. 



INFLUENCE OF THE RECTUM. 123 

tice was carried so far as to induce emissions of blood. His testicles 
became painful ; his urethra was exceedingly sensitive ; and the ap- 
plication of blisters induced nocturnal emissions for the first time. It 
seemed, therefore, unnecessary to seek further for the cause of the 
seminal discharges which wore the patient out; yet the result proved 
that they were kept up by the presence of ascarides in the rectum, 
the expulsion of which was followed by a sudden change and rapid im- 
provement, whilst no other treatment had produced the least amend- 
ment. This case shows how important it is to seek all the causes 
which may either excite or keep up involuntary seminal emissions. 

I say excite or keep up, because in this case the ascarides do not 
appear to me to have at all contributed to produce the disorder at its 
commencement. It was by the influence of bad example that Simon 

G was led to practise masturbation, and not by the presence of 

priapism, as is the case when the habit is excited by irritation from 
ascarides. The first nocturnal emissions too, followed the applica- 
tion of blisters ; and I shall, in a future chapter, have occasion to 
relate other cases of the same nature : such occurrences are easily 
explained by absorption of the cantharides. It seems likely, then, 
that the ascarides were only developed at a later period, and per- 
haps as a consequence of the deranged state of the patient's diges- 
tive organs. As they were not present in any very great quantity, 
it appears likely that they would not have produced such serious 
effects, if the spermatic organs had not been previously in a state 
of irritation; but I believe that in the existing state of the parts, 
the presence of the worms was sufficient to keep up involuntary noc- 
turnal and diurnal emissions. By reflecting on a few of the symp- 
toms that attended the spermatorrhoea in this case, I might have 
earlier discovered the presence of ascarides ; thus, the erections 
were frequent, prolonged, and importunate — circumstances the op- 
posite of those observed in patients worn out by ordinary pollutions. 
The troublesome itching, also, which constantly existed at the root 
of the penis, should have aroused my suspicions. 

CASE XXVIII. 

Masturbation at the age of ten — Seminal emissions produced by horse ex- 
ercise — Nocturnal, and afterwards diurnal, pollutions — Constant erec- 
tions — Stools relaxed, and containing abundance of mucus — Burning in 
the anus. Cauterization with slight benefit — Expulsion of ascarides fol- 
lowed by rapid and complete recovery. 

Alexander A— , of moderate stature, the son of robust peasants, en- 
ticed by the example of his companions, contracted, when about ten years 
old, the habit of masturbation, which he practised for a year before he ob- 
tained any seminal emission. From seventeen to eighteen he had sexual 
intercourse, but he afterwards returned to his former habits. He soon 
complained of general lassitude, weakness of the extremities, shortness of 
breath, and a sense of suffocation after the least exertion j loss of appetite ; 
difficulty of digestion. Very abundant seminal emissions were frequently 



124 CAUSES OF SPERMATORRHEA. 

excited "by horse exercise, and occurred without erection, although not 
without slight sensation. At a later period he suffered from severe and 
prolonged palpitation from slight causes; frequent colds, and an almost 
habitual cough, attended with expectoration of mucus mixed with much 

blood. At this period, A mentioned his condition to a medical man, 

who explained the cause of his disorders, and A at once corrected him- 
self; but nocturnal pollutions soon appeared. At first these were very fre- 
quent, but after a short time they only occurred three or four times a week, 
and at last only three or four times a month. Still the patient's palpitations, 
difficulty of breathing, and digestive disorder, continued to increase. Flushes 
of heat to the head were added to these symptoms, together with pain in the 
loins, which extended, with a creeping sensation, along the vertebral column, 
and was distributed to the shoulders and arms ; frequent cramps and chilli- 
ness of the extremities ; extreme weakness of the legs, and a frequent desire 
to micturate and defecate. The patient gave up music, in which he was a 
proficient, and took a dislike to society, especially that of women : timid, 
irritable, and unsettled, incessantly occupied by thinking of his disease, he 
was unfit for any occupation, became a prey to despair, and was several times 
on the point of yielding to the impulse to suicide, which constantly obtruded 
itself before him. 

In this condition A came to consult me, in the month of October, 

1836, being then twenty-one years of age. I at once perceived that the noc- 
turnal emissions had given place to diurnal ones, and the minute details into 
which the patient entered, confirmed me fully in this opinion. Each time 
that he went to stool, he had an emission from the penis of a greater or less 
quantity of viscid matter, which presented the characteristics of badly formed 
semen. His stools were repeated two or three times a day; they were liquid, 
contained a large quantity of mucus, and left a severe burning pain in the 
rectum. His urine was habitually muddy, thick, and of a disagreeable smell, 
and after its emission a thick gummy matter, which left a mark on his linen, 
remained at the orifice of the glans. The patient was, besides, annoyed day 
and night, with incomplete but very constant erections. 

Having observed, for several days, the presence of semen in the urine, I 
performed cauterization of the prostatic portion of the urethra. Fifteen days 
afterwards, a sensible improvement was evident in almost all the symptoms; 
yet no farther progress was made, notwithstanding the use of Spa water, iced 
milk, &c. The stools still continued liquid and mixed with mucus, resem- 
bling a thick solution of soap in water. This really dispiriting condition 
continued during three months, when I learned that the patient had several 
times noticed ascarides in his stools. 

In a few days after he was freed from this source of irritation by means 
of injections, and from that moment his re-establishment progressed rapidly. 
His love of occupation soon returned, and he applied himself diligently to 
the study of pharmacy. 

This, then, was a case in which the involuntary emissions were 
kept up by the irritation of ascarides in the rectum, although it would 
appear that masturbation was the cause of their origin. I have re- 
cently been consulted by one of my former pupils, for a similar case, 
in which the discharges were very serious, and had resisted the most 



INFLUENCE OF THE RECTUM. 125 

various modes of treatment. They were attributed to masturbation, 
and the patient's confessions justified this opinion ; yet a passage in 
bis letter convinced me that a mistake had arisen on, at least, one 
point. After speaking of supposed hemorrhoids, which irritated the 
margin of the anus, the patient added that the pain and itching he 
felt there were such, that he often introduced his finger forcibly into 
the rectum, and bad several times brought down ascarides on with- 
drawing it. This circumstance, previously neglected, caused me to 
think that the ascarides, if they had not caused the pollutions, at all 
events kept them up, and I prescribed accordingly, with success. 
We must remember, then, that the emissions may be kept up in per- 
sons who have practised masturbation, by the presence of ascarides, 
even in cases in which these entozoa have not excited the habit ; 
and on this account it is necessary to consider their presence with 
much attention. On the other hand, we must be on our guard"against 
attaching too much importance to the occasional presence of one or 
two of these worms in the faeces. In such cases, the want of success 
of vermifuge remedies shows that the ascarides are not of so much 
importance as they may have been considered. We must, therefore, 
be careful in all cases, not to draw conclusions too precipitately from 
first appearances. No disease, in fact, requires more patient research 
and greater tact in its diagnosis and treatment, than are necessary 
in complicated cases of spermatorrhoea. 

To resume. The cases reported in this chapter show that affec- 
tions of the rectum excite involuntary emissions. First, mechani- 
cally; by compressing the seminal vesicles during the passage of 
faeces. Secondly, vitally ; by the extension of irritation from the 
rectum to the seminal vesicles. 

All causes which oppose an obstacle to the exit of feces act in 
the former manner. I have recorded cases in which the mechanical 
obstacle was placed at the margin of the anus, (cases 15, 16, 17, and 
18,) because, in such cases, the cause is perfectly isolated, and its 
action is evident ; but it is also evident that any physical action like 
that resulting from horse exercise, (nineteenth case,) from carriage 
exercise, or from remaining too long in a sitting posture, as well as 
all medicines which tend to produce constipation, may be followed 
by the same effects. In all cases of this kind the influence of the 
rectum on the seminal vesicles arises from its distention by feces, 
and is a perfectly mechanical action. 

The other phenomenon is essentially vital. The diarrhoea, (case 
sixteenth) the ascarides, (cases 22, 23, 24, 25, 26, 27, 28,) and the 
eruptions at the anus, (case twelve) could only act in this manner. 
The same may be said concerning the action of injections, either too 
hot or too cold, and of certain drastic purgatives. 

In many cases too, the distention and the irritability of the intes- 
tine act simultaneously on the seminal vesicles. Hemorrhoids and 
fissures of the anus, for instance, cause pain and irritation, and give 
rise to spasms of the sphincter, at the same time that they form an 



126 CAUSES OF SPERMATORRHOEA. 

obstacle to defecation. Obstinate and continued costiveness too, is 
rarely exempt from heat and irritation in the rectum and its neigh- 
bourhood ; and eruptions about the anus are often accompanied by 
an irritability of the sphincters, opposing defecation. 

We have seen (case twenty-one) that chronic inflammation of the 
urinary organs may excite, by its influence, so great a susceptibility 
of the rectum, that the feces are no longer able to be retained ; and 
here cauterization of the mucous membrane of the genito-urinary 
passage sufficed to dispel the irritation of the rectum, so that the 
patient got rid, at once, of his diarrhoea, his incontinence of urine, 
and his involuntary seminal discharges. The influence of the rec- 
tum on the genito-urinary organs is then reciprocal ; and it plays a 
much more important part in causing spermatorrhoea, than if it 
acted only by mechanically compressing the seminal vesicles. Its 
due consideration is, therefore, of much importance in the treat- 
ment of these cases. 



CHAPTER VI. 

CAUSES OF SPERMATORRHOEA. 
Abuse. 

I understand by the term abuse, when applied to the organs of 
generation, any irregular or premature exercise of their functions ; 
any application of them which cannot have, as its result, the propa- 
gation of the species. There are, undoubtedly, many points of re- 
semblance between such abuses and venereal excesses, but the plan 
of this work requires that I should examine them separately. 

I concluded the last chapter by relating some cases in which the 
presence of ascarides in the rectum, more or less connected with 
masturbation, induced or kept up involuntary spermatic discharges ; 
I shall commence the present one by relating some cases in which 
the spermatorrhoea was due to masturbation alone. 

CASE XXIX. 

Masturbation — Nocturnal pollutions — Palpitation and dyspnoea, simulating 
cardiac disease-*— Repeated venesection, followed, by increased disorder — 
Sulphuretted baths, and rapid recovery. 

M. D , of nervous temperament, and energetic and restless charac- 
ter, contracted the practice of masturbation while at school. Shortly after- 
wards he suffered from a severe attack of fever, which occasioned his re- 
moval; this fever was followed by loss of voice, and afterwards by rheu- 



ABUSE. 127 

matic pains, pain in the chest, sensation of suffocation, habitual shortness 
of breath, and violent palpitations, which were increased on the slightest 
exertion. At the age of nineteen he broke himself of his habits; but, soon 
afterwards, he experienced nocturnal pollutions, which became daily more 
and more frequent. About this time an issue was inserted in his left thigh. 
The following winter the palpitations and difficulty of breathing increased, 
and his legs became slightly oedematous ; he was treated by repeated vene- 
sections, and the administration of diuretics, and at the approach of summer 
he became a little better, the improvement being of course attributed to the 
effects of the medical treatment. 

The following winter the same symptoms reappeared, and were again 
combated by venesection, with a severe regimen. The patient now became 
exceedingly emaciated. His nocturnal emissions increased in frequency, and 
his dyspnoea and palpitations were aggravated. For these symptoms he was 
again bled three times. 

At the age of twenty-three M. D came to Montpellier. A minute 

examination of his chest assured me that his lungs were perfectly healthy, 
and that the heart's action was neither more violent, nor heard over a greater 
extent than natural ; still, notwithstanding his emaciation and extreme de- 
bility, and the oedematous state of his legs, he was constantly recurring to 
the supposed plethora, to which his attendants had attributed his symptoms. 
I found it difficult to prevent him from having recourse to further abstrac- 
tion of blood. 

The use of artificial sulphuretted baths gave tone to his genital organs, 
and diminished their excessive irritability. The nocturnal pollutions be- 
came less frequent ; the patient's appetite returned, and his digestion was 
performed with greater energy. After a month's treatment, I sent him to 
the sulphuretted waters of the Pyrenees, where his cure was soon com- 
pleted. 

This is one of the most simple cases of nocturnal pollutions in- 
duced by masturbation. It is chiefly remarkable on account of the 
predominance of the palpitations and dyspnoea over the other symp- 
toms, and the grave errors which had been committed in its diag- 
nosis and treatment. 

CASE XXX. 

Masturbation at the age of eight years— At twelve, very frequent emission 
of urine — At sixteen, coitus impossible — Nocturnal, and afterwards, di- 
urnal pollutions — Cauterization, at the age of twenty-eight, followed by 
rapid recovery. 

M. D , of Philadelphia, of a very robust constitution, contracted the 

habit of masturbation at school, when only eight years old. The first effect 
produced was a frequent desire to pass urine, and at twelve years of age 
this irritability had become so great, that he was sometimes unable to retain 
his urine a quarter of an hour. Before entering a house he always took 
care to micturate several times in rapid succession ; and, notwithstanding 
this precaution, he soon experienced renewed uneasiness. He felt as 
though his bladder was never entirely empty, and the smallest quantity of 
urine induced spasmodic contractions. The irritability of the urinary 



I2S CAUSES OF SPERMATORRHOEA 






organs diminished by degrees after the period of puberty, but never ceased 
entirely, notwithstanding the various means which were employed on different 
occasions. 

At the age of sixteen, M. D endeavoured to break off his injurious 

habits by sexual intercourse, but he found himself completely impotent, and 
shame induced him to return to masturbation. He afterwards made further 
attempts to correct himself, but he experienced nocturnal pollutions, which 
often made him lose courage. At length, after many relapses, he succeeded 
completely, without observing any further nocturnal emissions. Still his 
health, instead of improving, became more and more impaired. His erec- 
tions were less frequent, less prolonged, incomplete, and at length gradually 
ceased, together with all venereal desire. 

At the age of twenty-eight, the state of his urine, its frequent discharge, 
and the wandering pains in the perineum and testicles, induced a fear of cal- 
culus ; sounding, however, only showed a morbid sensibility of the urethra, 
especially towards the neck of the bladder. 

In the beginning of May, 1837, M. D came to Montpellier, in the 

following condition : — much debilitated ; unsteady in his walk; easily chilled, 
and taking cold very quickly ; wandering pains all over his body; skin dry ; 
memory impaired; digestion difficult; extremities cold; scrotum relaxed, 
and testicles soft, very sensitive, and often causing a dull pain, as if they 
were forcibly compressed; the semen (from the account he gave of the last 
nocturnal pollutions he had experienced,) clear, aqueous, and inodorous; 
seminal emissions with the last drops of urine, which were clammy, and 
passed with difficulty, and excited a sensation of tickling in the neighbour- 
hood of the anus, which extended to the orifice of the urethra ; he often had 
diarrhoea, but at other times was very costive, and his stools were passed 
with difficulty and pain. He did not, however, often pass semen while at 
stool. 

I discovered, several days following, the presence of semen in M. D J s 

urine, and catheterism showed an excessive irritability of the urethra, espe- 
cially in the neighbourhood of the prostate, which, on examination, was 
found slightly enlarged. Nearly a table-spoonful of blood followed the 
withdrawal of the catheter. These circumstances did not leave the least 
doubt on my mind as to the state of the mucous membrane in the vicinity 
of the ejaculatory ducts; and, consequently, I immediately performed cau- 
terization, from the neck of the bladder, as far as the membranous portion of 

the urethra. Twenty days afterwards, M. D left Montpellier for Italy,, 

and when he returned, three months afterwards, he was completely cured — 
no involuntary seminal emissions having afterwards appeared. His urine 
was transparent, and could be retained seven or eight hours without incon- 
venience; its discharge took place without effort, and was not accompanied 
by any remarkable sensation. Lastly, the patient's impotence, which had 
been present nearly twelve years, had given place to a virility previously un- 
known to him : I need hardly state that his physical and moral energy had 
shared in this regeneration. 

I have often had occasion to notice the connexion that exists be- 
tween the spermatic and urinary organs ; and I have shown that there 
is scarcely a cause of spermatorrhoea which does not act more or less 
on the bladder and kidneys. The cause I am now investigating 



ABUSE. 129 

affords us numerous examples of this connexion — of which the case 
I have just related is a remarkable instance — the irritation of the 
urinary organs having been developed very rapidly, having shown 
very marked symptoms, and having existed alone during several 
years. The patient was only eight years of age when he first became 
addicted to masturbation ; at this early age the urinary organs alone 
possessed activity, and therefore they alone were able to suffer dis- 
turbance of their functions ; on this account the symptoms were con- 
fined for a long time to the urinary organs. The character of the 
symptoms showed that they arose from a chronic state of inflammation, 
or from an acute irritation of the urinary organs, and this state must 
have extended also towards the spermatic organs. Thus the in- 
creased secretion of the kidneys, and the extreme irritability of the 
bladder, would give a very clear idea of what took place in the sper- 
matic organs at the period of puberty. As soon as the testicles began 
to act, they fell under the same influence as the kidneys ; the seminal 
vesicles were in the same condition as the bladder ; in other words, 
the semen was secreted in large quantities, and was retained a very 
short time in its reservoirs. Being, therefore, imperfectly formed, the 
usual effect on the erectile tissues produced by its presence, did not 
take place, and coitus was impossible at the age of sixteen. The 
occurrence of impotence at so early an age is sufficient to show that 
diurnal pollutions had already commenced, although the patient did 
not discover them for a long time afterwards. He was still, however, 
able to practise masturbation ; and this is a circumstance which has 
great effect in preventing persons addicted to the vice from renouncing 
their fatal habits. At a later period, nocturnal pollutions, which 
occurred after a few days' care, shook the patient's resolution. This 
is a much less serious circumstance than the one just mentioned, but 
at the same time much more common. At length the patient left off 
his habits, and his nocturnal pollutions disappeared; yet the disorder 
of his health continued to increase. His prudence, exercised too 
late, did not arise from the strength of his will, but from the weakness 
of his genital organs ; the disappearance of his nocturnal emissions 
did not arise from the remedial measures used, but from the increase 
of his involuntary diurnal discharges, of which he only became aware 
long afterwards. These common errors are the more dangerous, be- 
cause medical practitioners are apt to participate in them. 

In the case of M. D the irritability of the canal was very great, 

and the effect of the cauterization was correspondingly prompt and 
decided. 



CAUSES OF SPERMATORRHEA. 



CASE XXXI. 

Masturbation at the age of seventeen, carried so far as to cause emissions 
of blood, but \soon afterwards abandoned — Increasing debility during 
four years — Symptoms of phthisis laryngea and chronic gastritis — 
Extreme prostration — Cauterization, followed by rapid re-establishment. 

I am indebted for the following remarkable case to the kindness of Dr. 

Daniel, of Cette. "On the 26th of May, 1836, I was called to F , a 

baker, aged twenty-two. I found him in bed, in the following condition: — 
great moral prostration, carried even to a hatred of existence; prostration 
of strength; emesia; lips pale and shrivelled; remarkable pallidity; eyes 
sunken; expression of countenance dull; great emaciation • skin hot and 
dry; pulse small; voice hoarse, and so low that it was with difficulty a few 
words could be heard by approaching the ear; constant cough, scarcely 
permitting an instant's repose; general wandering pains, most severe in the 
loins and the sides of the chest; great irritability of the stomach — vomiting 
being excited after taking almost any kind of liquid or solid food. 

"At first I thought that I recognised in this patient the symptoms of phthisis 
laryngea, complicated with chronic gastritis; but the examination of his 
chest and abdomen did not support this opinion. The epigastric region 
was not painful on pressure; the respiratory murmur was heard all over the 
chest, and percussion emitted a healthy sound, except under the left false 
ribs, where it was slightly dull, and the patient felt pain. 

"His debility did not permit me to practise abstraction of blood; and, 
indeed, the pleuropneumonia of the left side did not seem either very ex- 
tensive or very acute ; I therefore ordered a large blister to be applied over 
the affected spot, and prescribed a solution of tartar emetic, and a strict 
diet. The pain in the side disappeared, and two days afterwards the sto- 
mach could retain milk and barley water. Still nothing explained the 
patient's emaciation; his almost total loss of voice, hoarseness, and constant 
cough. His parents attributed these symptoms to hereditary phthisis, and 
mentioned that several members of the family had died of that disease. 

Minute and repeated examination of F 's chest, however, assured me 

that this was not the case. On the other hand, the symptoms were very 
severe, and I could not discover any visceral lesion sufficient to account 
for them. In this state of uncertainty, your views on spermatorrhoea 
attracted my attention. I immediately questioned the patient respecting his 
past life, and learnt that at the age of seventeen he had practised mastur- 
bation with such fury that he had frequently passed aqueous semen, mixed 
with blood : frightened by these accidents, he had corrected himself com- 
pletely. But, after about a fortnight's abstinence, he noticed that his urine 
contained a deposit of thick, whitish, flocculent matter. He never attached 
any importance to this, although during four years he observed it con- 
stantly, and noticed that it was more abundant after he had been much 
fatigued in his business. He observed also, that the last drops of urine 
were thick and viscid, and that a small quantity of viscid matter generally 
remained at the orifice of the urethra. His bad symptoms first commenced 
at this time; his erections and desires entirely disappeared; and, by the 
time he had attained the age of twenty-one, he was obliged to give up his 



ABUSE. 131 

employment, and shortly afterwards, his symptoms becoming aggravated, 
he was unable to quit his bed. 

"I examined his urine, and found it in the condition he had described; 
the deposit contained in it being about an ounce in quantity. I noticed 
that his testicles were soft, and his scrotum flaccid. He agreed to my 
proposition of cauterizing the prostatic portion of the urethra with eager- 
ness, and I performed it on the following day. The effect of the cauteriza- 
tion was rapid: the second night afterwards, the patient slept soundly; the 
third day, a change was observed in his voice; and erections occurred 
during the night. On the fourth day, the patient was able to get up and 
take some light food, which was well digested; his wandering pains had 
disappeared; and by the ninth day after the cauterization, the patient's 
strength had returned. Tonic regimen, and the use of sea bathing, con- 
firmed his restoration." 

Dr. Daniel added to the history of this case a detailed statement 
drawn up by this patient himself: as it contains no important facts, I 
have omitted it here. I have, however, several times myself exa- 
mined this patient, and have assured myself of the exactitude of the 
report. 

F had carried masturbation to such an extent, that he passed 

aqueous semen, mixed with blood ; the seminal vesicles were there- 
fore in a morbid condition when he left off the habit. A fortnight 
afterwards, he noticed a deposit in his urine, which he had never 
before perceived, and which continued constantly afterwards. During 
four years, he never relapsed into his former habits, and he was not 
affected by nocturnal emissions ; yet he continued to lose flesh. Im- 
mediately after the cauterization he became convalescent. Is it not 
evident, that the absence of venereal desires and of nocturnal emis- 
sions during so long a period, was owing to the occurrence of invo- 
luntary diurnal pollutions? Is there any other mode by which we 
can explain the continued disorder of the patient's health, and its 
sudden restoration? The answer is evident. 

Whenever F fatigued himself more than usual, the urinary 

deposit became more abundant. This may appear to be an excep- 
tion to the usual good effects which patients experience from pedes- 
trian exercise. Every thing depends on the strength of the system, 
and on the quantity of that strength expended. Fatigue is as hurtful 
in such cases, as exercise is beneficial. 



CASE XXXII. 

Masturbation from twelve to twenty-two years of age — 3IclancJwly — In- 
clination to suicide — Serious alteration of the health — Monomania — 
Unperceived diurnal pollutions — Cauterization followed by perfect re- 
covery. 

At the beginning of April, 1836, M. Emile G was sent to consult 

me, by Dr. Cauviere of Marseilles. He was twenty-five years of age, and 



132 CAUSES OF SPERMATORRHEA. 

had attracted notice from the brilliancy of his intellect. At twenty-one 
years of age, he had been admitted an advocate in a highly flattering 
manner. 

He stooped much, and though his bony system seemed to announce a 
strong constitution, his limbs were small, and his muscles soft. His hair 
was black and thin, his skin was pale, and his face without expression. 
His eyes were dull, and constantly cast down; his voice weak and husky; 
and his general appearance announced great timidity. His legs were con- 
stantly in motion. 

I learnt that M. Gr had contracted the habit of masturbation at 

school, at twelve years of age; and that whilst studying law in Paris, at 
the age of nineteen he found a change in his character ^commencing: this 
I will describe in his own words: — At first I felt a gradually increasing 
disgust of every thing and a constant sense of ennui. From that period I 
only saw the dark side of life. Thoughts of suicide soon afterwards oc- 
curred to me, and this state of mind continued for twelve months, after 
which other ideas took the place of those respecting suicide. I considered 
myself a subject of ridicule, and fancied that the expression of my counte- 
nance, or my manner, excited an insulting gaiety in the persons I met. 
This notion each day acquired new strength, and often when in the street, 
or even when at my own house, or in a room surrounded by my relations 
and friends, I fancied I heard insults which were aimed at me. / think so 
still. At length, as my state became worse, I thought that every one in- 
sulted me, and I still think so. If any one expectorates or blows his nose, 
coughs, laughs, or puts his hand or his handkerchief before his face in my 
presence, I experience the most painful sensation. Sometimes, I feel en- 
raged, but more frequently a depression of spirits, ending in involuntary 
tears. I look at no one, and my eyes are never fixed on any object. 
"Wrapped up in my own thoughts, I am indifferent to all external impres- 
sions. These signs are evidently those of imbecility. I admit that I may 
have had, and that I may even now have, hallucinations, but I am fully 
persuaded that these ideas are not without foundation; I am convinced that 
the expression of my countenance has something strange in it, that people 
read in my looks the fears which agitate, and the ideas which torment me, 
and that they laugh at this unhappy weakness of intellect, which they ought 
rather to pity." 

The patient experienced a sense of heaviness and oppression in his head, 
and although fatigued by slight exercise was constantly in motion. Two 
years before he consulted me he began to correct himself by degrees ; and 
for nine months he had entirely renounced the practice of masturbation, 
yet notwithstanding this, his state daily grew worse. His digestion was 
disordered; he suffered from obstinate constipation; and his erections and 
venereal desires had left him for a long time. Yet he did not mention the 
last facts in the written statement of his case which he sent me; they were 
minor evils; one idea alone absorbed him — the conviction that he was an 
object of contempt and ridicule to all who approached him; this idea was 
aggravated by the knowledge of his impotence, and by shame for the cause 
which had produced it. 

This patient's urine usually contained an abundant flocculent deposit, 
resembling a thick decoction of barley; it decomposed very rapidly, and 
emitted a disagreeable smell. After every stool the point of the glans penis 
was covered with a clammy viscid matter, resembling a thick solution of 
gum. 



ABUSE. 133 

These circumstances confirmed me in the idea that involuntary seminal 
discharges alone opposed the patient's recovery. The frequent emission 
of his urine; the sensibility of the spermatic cord, of the testicles, and 
especially of the urethral mucous membrane, and the injected state of the 
orifice of the urethra, made me attribute these evacuations to irritation of the 
spermatic organs rather than to their relaxation. 

As, however, the patient refused to submit to cauterization, I ordered him 
iced milk mixed with spa water, cold lotions, &c. ; but he found himself 
much worse after the use of these means; all his symptoms were aggra- 
vated; his urine became thicker, and left a glairy deposit adhering to the 
bottom of the vessel. 

At, length, on the 23d of April, I persuaded M. Gr to submit to cau- 
terization, and I performed it immediately, chiefly on the neck of the bladder 
and the prostatic portion of the urethra : nothing particular occurred, except 
that the inflammation of the urethra, which followed the application, was 
not entirely removed for three weeks. This I believe arose, in a great 
measure, from the severe weather which prevailed at the time. I ordered 
two or three warm baths to be taken in the week, a few warm injections 
and demulcent drinks. At the expiration of a month, the patient took 
pleasure in going out, and occupied himself with gardening; he felt stronger, 
and took longer walks; he was able to employ himself longer without 
fatigue; he also experienced nocturnal emissions, preceded by erotic dreams 
and lively sensations. At this he was at first alarmed, but he gained courage 
when he saw that he was not injured by them. I had not seen him for 
more than a month, when one day he called on me quite dispirited, to say 
that he should never get well, as he was relapsing into his former habits. 
I blamed him, but at the same time I explained to him that the fact was a 
proof of his having regained his former virility, of which he should make 
more proper use. M. Gr — — 's mother came to me soon after to speak of 
the propriety of marriage for her son, whom she saw exposed to various 
dangers. I easily persuaded her, that before deciding on marriage, it would 
be necessary for him to be firmly assured, during a considerable period, 

of his perfect and decided recovery. M. Gr had then regained his 

spirits, his boldness, and his position in society, and eighteen months after- 
wards, all his functions being performed with energy, he married. Six 
months after his marriage I heard that his health had not for a moment been 
disordered. 

With this patient I received the following consultation from Dr. 
Esquirol. "The undersigned cannot mistake a case of hypochondriasis 
which has lasted three years. It is evident that the nervous affection 
was produced by the habit of masturbation to which the patient was 
addicted from the age of puberty, and of which he only succeeded in 
breaking himself seven months since. The hypochondriasis continues 
very obstinately, as the cause which produced it acted for a long time, 
and very seriously weakened the nervous system. The undersigned 
attributes the little success attending medical treatment to the unfa- 
vourable weather, to the indocility of the patient, who lives in seclu- 
sion and in physical and moral torpor, and to the weakness of his 
mother, who allows herself to be led away by the sight of false or 
exaggerated sufferings. The means advised are those usually ordered 



134 CAUSES OF SPERMATORRHEA. 

in cases of hypochondriasis: — Tonics, antispasmodics, leeches to the 
anus, purging, change of scene, travelling, sulphuretted baths, sea- 
bathing," &c. Dr. Esquirol sums up his opinion, in concluding, as 
follows : — " I must repeat what I have said above: weakened innerva- 
tion is the cause of the disease, and every thing which can strengthen 
the nervous system will be useful." It was clear that masturbation 
had been the first cause of the physical and moral derangement, called 
hypochondriasis ; but the patient had renounced this vice during nine 
months, and his state became worse daily, instead of improving. It 
was evident, therefore, that some other cause acted in keeping up the 
disorder; and it was just as evident that this cause was involuntary 
diurnal seminal discharges. It is not necessary for me to show that 
masturbation can, acting alone, induce involuntary discharges, or that 
the cure was due to cauterization only, although its effects were not 
manifest for a month after the application of the caustic ; but I must 
insist on the pathological condition of the genital organs exciting these 
involuntary evacuations, since they have been too frequently ascribed 
to a state of debility or relaxation of the tissues. The tonics ordered 
by Esquirol had produced no benefit: I have described the symptoms 
which led me to suspect acute irritation of the prostatic portion of the 
urethra, and I have shown the injurious effects of cold lotions, iced 
milk, spa water, &c. It was, then, not by causing contraction of the 
orifices of the ejaculatory canals, that the cauterization produced its 
beneficial effects, but by dispersing the chronic engorgement of the 
mucous membrane. The advantage derived from warm baths during 
convalescence corroborates this opinion. 

In M. G 's case a predominating symptom attracted the atten- 
tion of the practitioners ; hence they looked on the disease as being 
hypochondriasis, monomania, or hallucination, continuing after the 
cessation of its exciting cause, and becoming, consequently, an idio- 
pathic affection. I have, however, shown that all the functions had 
been altered more or less ; I should add, that the digestion was the 
last to be re-established perfectly. Such mistakes are very common, 
and very serious, and I cannot too strongly impress their importance 
on the attention of the profession. Esquirol justly stated that the 
hypochondriasis took its origin from masturbation ; that the nervous 
system was weak and excited ; but he mistook the cause which kept 
up this condition of the brain. When masturbation has not induced 
involuntary seminal emissions, recovery soon follows, on leaving off 
the habit which has destroyed the health; within a week the patients 
begin to experience a notable improvement, and in a very short time 
they are hardly recognisable, whatever may have been the degree of 
weakness to which they were reduced. But when Dr. Esquirol wrote 

his opinion, seven months had elapsed, during which M. G 's 

conduct had been irreproachable, and when I saw him two months 
later, his state was even worse, although he had never resumed his 
former habits. The symptoms were, however, kept up by involun- 
tary diurnal discharges. 



ABUSE. 135 

The effects of the cauterization were very conclusive, and as soon 
as its curative action was felt, the patient, of his own accord, took 
various kinds of exercise, and sought out the different amusements 
which had been, in vain, ordered for him previously ; he entered into 
society, and did, without being pressed, all that he had before refused 
to do ; his ideas and his necessities altered in proportion as his func- 
tions were re-established. 

It is in vain that we say to the so called hypochondriac, — amuse 
yourself, employ your mind, go into society, seek agreeable conver- 
sation ; so long as we have not removed the cause of his disorder, he 
is unable to profit by our counsels. How can we expect that when 
a man is fatigued by the least exercise, he shall occupy himself with 
walking or gardening? How can we desire him to go into society, 
when the simple presence of a woman intimidates him, and recalls all 
his former misfortunes? How can we expect him to enjoy conversa- 
tion, when he loses its thread every moment? When his memory 
leaves him, and when he feels his nullity? We persuade him to 
seek amusements and pleasures, but are they such to him? Is not 
the happiness of others his greatest punishment ? Because he is una- 
ble to follow our advice we accuse him of unwillingness, and we wish 
to compel him. Let us first remove the cause of our patient's dis- 
ease, and we shall soon see that his character and conduct will 
change, and that he will return to his natural tastes and habits. 

It is not long, in such cases, before we are embarrassed by ques- 
tions about the propriety of marriage being put to us : this is a matter 
which is serious in all its aspects, and on which the least scrupulous 
should not pronounce, without having had sufficient assurance of 
their patient's return to health. The question of our patient's health 
is now not the only one, nor is even his future happiness alone impli- 
cated; the fate of the innocent being who is about to be associated 
with him, is the matter of chief importance, and justice to her de- 
mands that we do not counsel matrimony, until sufficiently long proof 
has been given that our patient's re-establishment is permanent. 



CASE XXXIII. 

Abuse caused by sleeping . on the belly — Effects of reading erotic works — 
Power of habit — Alteration of the intellectual and moral faculties — 
Impotence — Chronic Irritation of the bladder — Nocturnal and diurnal 
pollutions — Cauterization followed by prompt recovery. 

Eugene C , at seven years of age, was strong and healthy, but about 

this period he contracted the habit of lying on his belly at night. In this 
position the genital organs were heated during sleep, and the penis became 
erect, although the boy did not present the least sign of puberty. Pressure 
against the bed produced titillation, and induced a habit of abuse, as in- 
jurious in its effects as masturbation. The child was perfectly free from 
any sexual feelings, and had never been exposed to the influence of bad 
example; besides which, he was naturally modest and reserved. The first 




136 CAUSES OF SPERMATORRHOEA. 

impression was, therefore, quite instinctive and accidental, but the habit 
was soon confirmed into an irresistible passion. 

Between the ages of nine and eleven the child's character changed; he 
became restless and quarrelsome, but his intellectual faculties were active, 
and he was able to keep up* with his companions in their studies, and to make 
himself feared by them, on account of his quarrelsome disposition. Be- 
tween the ages of eleven and thirteen, however, he yielded to the practice, 
two or three times a night, and became idle, timid, and weak; he fell behind 
his fellow students in his studies; and though he was easily provoked 
to quarrel, he found himself always beaten. On this account he sought 
solitude. At the age of fourteen, the habit he had contracted was tempo- 
rarily broken off, by his brother's sleeping with him; but at the expiration 
of three months, when left to himself, he relapsed. At the age of fifteen, a 
remonstrance received before his fellow students by one of his masters, 
caused him to abstain during eight months; he regained his strength, his 
character altered, and he made up for the time he had lost in his studies. 

At the end of the year he even wrote so remarkable an essay at the com- 
petition for prizes, that he was supposed to have copied it. On this account, 
at another competition some time afterwards, he was separated from his 
companions, and carefully watched. In the mean time, however, some 
obscene books had fallen in his way, and excited his imagination. He re- 
sumed his habits with fury, and when the day of competition arrived, his 
condition had become worse than ever. He passed all the time allowed for 
the trial in a state of febrile excitement, without writing a word. Some 
time afterwards, he made a strong resolution to correct himself, but the habit 
had become so strong, that he often had recourse to it, unconsciously, 
during sleep. By degrees, however, he corrected himself, but very frequent 
nocturnal pollutions supervened, and destroyed all the benefit that arose 
from the change. 

At the age of seventeen the patient came to Montpellier to obtain the 
degree of bachelor of letters : the state of his intellectual faculties prevented 
this; indeed, out of ten hours spent in his study, nine were passed in think- 
ing of his condition, and of the different means by which he could commit 
suicide. He attempted sexual intercourse, but found himself quite impo- 
tent. Horse exercise, and the various tonics and stimulants which were 
prescribed for him, only increased his disorder. 

I need not relate all the functional derangements which the patient under- 
went; but it is necessary that I should notice a chronic inflammation of the 
bladder, of which the cause was unknown, and diurnal pollutions, which he 
did not discover, although they were much more serious than the nocturnal 
emissions which had become more and more rare during the previous twelve 
months. 

About the end of November, 1836, I cauterized the neck of the bladder, 
and the prostatic portion of the urethra. Fifteen days afterwards, the pa- 
tient was better, and he immediately went into the country, where his cure 
was soon confirmed. 

M. C has since studied medicine with much energy; and has 

passed the examinations of B. L. and B. A. with credit. His character 
has become frank and kind, and it is evident that he is in* good health and 
spirits. 

This case shows the importance of the apparent trifles that occur in 



ABUSE. 137 

childhood, and at the period of puberty; and the serious effects which 
a slight neglect of them may produce during the whole of after life. 

CASE XXXIY. 

Sexual ideas at the age of eight — Abuse at thirteen — Various diseases in 
consequence, until the age of thirty -two — Nocturnal and diurnal pollutions 
— Cauterization — Slmv, but progressive improvement. 

M. A , when a child, was remarkable for precocity of intellect; but 

was troubled with worms during the early years of his life. Being allowed 
to sleep with his governess, when about eight years of age, he remarked 
differences of form, which he had never before seen. His active imagina- 
tion dwelt on these incessantly and at length he fell into a state of melan- 
choly, of which the cause was far from being suspected. At the age of 
thirteen, a young female took advantage of him, but without permitting 
intromission. Shortly afterwards, when at school, these circumstances 
constantly recurred to his imagination, and during the night he took care 
to place himself as much as possible in the same position, in order to renew 
the same sensations. He thus contracted a habit quite as injurious as 
masturbation. His health became affected, even before any seminal emis- 
sion had taken place; his growth was arrested; his sight, memory, and 
intellect, became weak. At the age of seventeen, emissions occurred during 
defecation, and were followed by a diminution of the patient's erections and 
venereal desires, as well as of his abuses. At nineteen years of age, he had 
a chronic gastritis, head-ache, pain in the hypochondriac regions, and noc- 
turnal pollutions. For these symptoms, a milk diet was prescribed, and 
adhered to for a year, together with baths, enemata, and country exercise. 
At the age of twenty-two, chronic gastro-enteritis supervened, and was fol- 
lowed by inflammation of the bladder, which passed into a state of chronic 
vesical catarrh. After about two years, the patient's health was restored. 
By degrees, his old habits and nocturnal pollutions returned, and induced 
a new derangement of his health; at the age of twenty -five, chronic inflam- 
mation of the digestive organs and bladder again appeared, but was re- 
lieved by emollients and a severe regimen. About the age of twenty-eight, 
his health partially returned, but his sleep continued heavy and unrefresh- 
ing, and was often interrupted. At thirty, his digestion was much disor- 
dered; constipation and diarrhoea occurring alternately. 

The patient's condition gradually became worse, until he came to Mont- 
pellier, in February, 1836. He was then thirty-two years of age, and pre- 
sented the following symptoms: appearance, sad, restless, and timid; legs 
weak; constant restlessness; feeling of icy coldness in the thighs, lower 
part of the belly, and genital organs; appetite capricious; digestion 
laborious, and accompanied with discharge of flatus; memory treache- 
rous; dislike of society; irritability of temper; overruling egotism; constant 
presence of lascivious ideas, contrasting strongly with the weakness of the 
genital organs; mental debility; sleep broken, and unrefreshing; frightful 
dreams; frequent desire to micturate, especially during the night; urine 
thick and muddy, generally presenting an abundant flocculent precipitate, 
and giving off a disagreeable smell; genital organs very little developed; 
prepuce long; and testicles small. 

After observing the patient for several days, I cauterized the bladder and 



138 CAUSES OF SPERMATORRHEA. 

prostatic portion of the urethra; the operation was followed by a more in- 
tense inflammation than usual, probably due to the bad weather. As soon 
as he was able, the patient quitted Montpellier, to return home. 

Not having heard from him, I augured that the cauterization had been 
unsuccessful, when one day, several months afterwards, as I was passing 

through Lyons, I was accosted by M. A -, who was so changed that I 

hardly recognised him. He stated, that a slow, but progressive improve- 
ment had taken place after his leaving Montpellier; the pollutions he had 
before experienced during defecation disappeared; his urine became clear, 
and was passed less often and less suddenly; nocturnal pollutions occurred 
seldom, and his erections became energetic. 

The abuses practised on the genital organs had the same cha- 
racter in this, as in the preceding case ; and in both, they produced 
the same effects as masturbation. We observe in the last case, 
that sexual ideas preceded for a long time the development of the 
sexual organs ; and that the venereal desires had no relation what- 
ever to the amount of development of the generative organs. 

The influence of a premature liaison on these abuses is also 
worthy of notice. The remembrance of such irregular and prema- 
ture enjoyments constantly presented itself before the patient's 
imagination, and caused his frequent relapses. The habit at length 
overcame the will, and even took its place, provoking the same acts 
during sleep. The power of habit was just the same in the pre- 
ceding case. 

At the age of seventeen, M. A noticed that he passed semen 

while at stool ; he had therefore, thus early, diurnal pollutions. He 
did not pay attention to these, because he was not aware of their 
importance ; but it is evidently to the occurrence of such discharges, 
that we must attribute the feebleness of his erections, the impossi- 
bility of coitus, and the long series of sufferings he afterwards en- 
dured. 

As to the other symptoms presented by M. A , I need not 

enter into their consideration, I have already done so several times, 
— such symptoms being common to all cases of spermatorrhoea. 

Were the discharges in this case due to a state of atony? This 
would seem to be the case, if we only regarded the small develop- 
ment of the organs, and the habitual weakness of the erections ; but 
the acute attack of cystitis, and the chronic catarrh of the bladder, 
showed clearly enough, that the seminal vesicles and ejaculatory 
canals must have been also in a state of irritation. The curative 
effects of cauterization were postponed for a considerable time, so 
that I almost despaired of benefit from the operation; yet, no other 
treatment having been employed, the improvement was evidently 
due to the cauterization alone. In case thirty-two, I have already 
noticed the same circumstance, and it is worthy of remark, that 
both these cases were operated on during a very wet and cold 
season. Whether this be the correct explanation or not, such cases 
are not rare, and I wish particularly to point them out, because I 



ABUSE. 139 

have met with many patients affected with spermatorrhoea, who had 
feeen cauterized three, four, or five times, or even still more often, 
in the space of a month. This subject I shall treat fully, when 
speaking of the treatment of spermatorrhoea. 

CASE XXXV. 

Masturbation at sixteen years of age — At twenty-one, compression of the 
urethra during ejaculation, followed by a sensation of tearing, and acute 
pain — Urethral discharge recurring frequently — Discharges of semen 
during defecation and the emission of urine — Reciprocal influence of these 
discharges on the digestive organs — Chronic catarrh of the bladder — 
Cauterization — Recovery, after several 



M. Gr , of sanguineous temperament, and robust constitution, con- 
tracted the habit of masturbation when about sixteen years old. The 
following year, he was troubled with disordered digestion, oppression, and 
difficulty of respiration. At the age of twenty-one, he determined to con- 
quer his propensity, but after a few days' continence, he relapsed, in conse- 
quence of the violent erections he experienced. During this contest between 
his will and his passion, he one day compressed the urethra forcibly, when 
on the point of ejaculation. On the instant, he experienced a sensation of 
tearing in the interior of the canal, followed by acute pain, which afterwards 
frequently returned; the following day, after an erection, he felt the glans 
wet, and found the orifice of the urethra filled with a viscid matter, resem- 
bling a very thick solution of gum. From that time, this kind of discharge 
always continued, varying only a little in appearance and quantity, according 
to circumstances; the patient's erections became less energetic, and the 
sensations produced by ejaculation grew progressively weaker: at the same 
time, the functions of his stomach were disordered and frequent attacks of 
indigestion took place. At the end of two years, the urethral discharge 
increased suddenly after coitus; at the same time assuming a blennorrhagic 
appearance. This was treated by emollients and copaiba, and at the end 
of three months, the former state returned; the discharge was easily in- 
creased, however, by the least error of diet, as well as by very slight venereal 
excitement. The patient's erections now became less energetic and incom- 
plete; and, on the other hand, his digestion was more and more disordered 
and accompanied with colic, flatulence, and constipation — the efforts at stool 
giving rise to seminal discharge. Various remedial means were adopted, 
but without success. At the age of twenty-eight, the patient, after a slight 
error of diet, experienced an exacerbation of all his symptoms, and in addi- 
tion, his urine became thick, muddy, and fetid, and its discharge very fre- 
quent, and accompanied by an acute pain at the root of the penis, and in 
the bladder. In this state the patient came to Montpellier, on the 19th of 
April, 1826, being then about thirty. After observing him for several days, 
I noticed that his urine was constantly muddy and fetid, and contained a 
red sediment, which adhered to. the sides of the vessel, and a thick and 
flocculent deposit, which fell to the bottom ; a slightly opaque cloud occu- 
pying the upper part, while on the surface a thin iridescent pellicle floated. 
The urethral mucous membrane was also very irritable, especially towards 
the neck of the bladder. On the 2d of May, I slightly cauterized the bladder 



140 CAUSES OF SPERMATORRHEA, 






near its neck, and more severely the prostatic portion of the urethra, closing 
the instrument before it reached the bulb. The operation produced its 
usual effects. Five days afterwards, the urine no longer contained blood, 
and within fifteen days it was passed without pain or inconvenience. A 
month after the operation the urine was quite clear, the digestive organs 
had regained their energy, and the patient was able to eat heartily without 
being inconvenienced. His stools became regular, and were passed easily; 
the seminal discharges diminished; his strength returned, and allowed him 
to take long walks, and his sleep became sound and refreshing. In this 

state of convalescence M. Gr left Montpellier, about six weeks after the 

cauterization. 

Five months afterwards, I received a letter from M. G- in which he 

stated that his recovery had proceeded by degrees, and that his health had 
been excellent during three months, when he had eaten a large quantity of 
grapes, some of which were not ripe ; a severe attack of indigestion resulted, 
after which his old symptoms returned, and strangely enough, he felt, during 
the emission of urine, a sensation in the prostatic portion of the urethra, re- 
sembling that produced by the application of caustic. He had scarcely re- 
covered from his relapse, when he a second time committed an error in diet, 
which brought on a more serious indigestion than the first, and was followed 

by an aggravation of all his former symptoms. In this condition M. G 

wrote for advice. Four months afterwards, I received another letter from 
him, stating, that before he had received my previous answer, he had en- 
tirely recovered; but that, forgetful of the past, he had suffered from ano- 
ther indigestion, with another slight attack of his former symptoms. I in- 
sisted on the necessity of strict diet, and further recommended a trial of the 
sulphureous waters of the Pyrenees. As I have not since heard from this 
patient, I am warranted in supposing that his health is at length permanently 
established. 

This case shows us the dangers which may arise from an imprudent 
compression of the urethral canal during the ejaculatory orgasm. 
Such attempts have been made for various reasons — sometimes in 
the hope of preventing a nocturnal pollution — and they are generally 
followed by the same result. 

At the moment of emission, a kind of tearing of the canal takes 
place ; this is attended with acute pain, and, in the case before us, 
was followed by a mucous discharge, which continued nearly ten 
years. 

The patient, as well as the different surgeons who attended him, 
regarded his discharge as spermatic, because it was increased by ve- 
nereal excitement, and because the patient's virility constantly dimi- 
nished, at the same time that the general symptoms of spermatorrhoea 
were present. But the circumstances which preceded the discharge 
were sufficient to show that it arose from the mucous follicles, inflamed 
or irritated by a laceration at some point of the passage. Was it 
astonishing, then, that every excitement of the organs should have 
increased this discharge. The blennorrhagic character which it pre- 
sented for some time proves, even still more certainly, that the dis- 
charge was not spermatic. The changes that took place in the 



ABUSE. 141 

patient's health, and in his generative functions, are explained by 
the occurrence of diurnal pollutions, both during defecation and the 
emission of urine; and the occurrence of these diurnal pollutions after 
chronic inflammation of the urethra is easily explained, by referring 
to the tendency of irritation to extend from the prostatic mucous 
membrane to the adjacent tissues. 

In consequence of this disposition, the urinary organs presented 
well marked symptoms of chronic inflammation, and the state of 
these gives a good idea of what was going on in the spermatic 
organs. 

We must conclude, then, that the constant discharge from the canal 
was only an ordinary blennorrhoea, and that the patient's impotence, 
and the derangement of his health, are to be attributed solely to the 
spermatic discharges which took place during defecation and the 
emission of urine. 

I have attached considerable importance to the right understanding 
this fact, because attacks of blennorrhagia are often complicated with 
diurnal pollutions, and this frequent coincidence has caused the utmost 
confusion in the opinions given on the subject, since Aretasus first 
spoke of a constant seminal discharge. It is at once evident, that the 
semen being contained in distinct reservoirs cannot constantly run off 
like the secretion of the open mucous follicles. I shall examine this 
simple question more fully in a future chapter, but, as I proceed, I 
shall show, as opportunities occur, that the symptoms attributed to 
these constant discharges arise really from unsuspected pollutions 
happening during defecation and the emission of the urine. 

Another result of this easy extension of irritation from the prostate 
to the adjacent mucous membrane in the case under consideration, 
was the chronic affection of the bladder, and probably also of the 
kidneys. I mention this circumstance here, to show how difficult 
all these complications render the diagnosis of diurnal pollutions. 
The urine contained an abundant lithic acid deposit, and was covered 
by an iridescent pellicle ; it was also muddy from the presence of a 
large quantity of mucus, a thicker deposit occupying the lower por- 
tion of the fluid. The abundance of salts contained in the secretion 
arose from the irritation of the kidneys; the bladder and the prostate 
furnished the greater part of the other matters ; but did the urine con- 
tain semen ? I believe that neither chemical analysis, nor microscopi- 
cal research, would have been able to decide this point. 

The last drops of urine emitted were of the viscid consistence of 
a solution of gum or starch, and this matter could only be semen. 

It is unfortunate that these complicated cases should be the most 
common, as well as the most serious. But of what importance to 
the practitioner is the existence of blennorrhagia, or the mixture of 
vesical mucus, of prostatic fluid, or of different salts, with the urine ? 
It is not from one symptom only, that he should judge of the disease, 
but from the whole. The most important point in these embarrass- 
ing cases, is to understand fully the cause and connexion of such 



142 CAUSES OF SPERMATORRHEA. 

complications, in order to asertain a means of cure. Happily, the 
same treatment is suited to all the symptoms, because they all de- 
pend on the same cause. In this case, for example, the cauterization 
put a stop at the same time to the blennorrhoea, the chronic affection 
of the bladder, and the diurnal pollutions — diseases that had existed 
nine or ten years. 

I may remark, in passing, that the curative effects of cauterization 
did not show themselves, in this case, until a month had -elapsed; 
and that from this time they progressed slowly, but steadily, so that 
the recovery was complete at the end of three months. This shows 
the impropriety of repeating the u£e of caustic without waiting to 
see the effects of the operation. 

Two remarkable features in the case were, the influence exer- 
cised by the spermatorrhoea over the digestive organs, and the effect 
which disordered digestion produced on the genital organs. The 
stomach was the organ which first suffered from the masturbation, 
and which, afterwards, was chiefly affected by the spermatorrhoea ; 
whilst on the other hand, a violent indigestion much increased the 
severity of the symptoms; and at a later period, when the cure 
seemed perfectly established, four attacks of indigestion were fol- 
lowed by an equal number of more or less serious relapses, and by 
diurnal pollutions, and irritation of the bladder, with pain in the 
urethra, resembling that caused by cauterization. But I shall re- 
sume the consideration of this sympathy between the generative 
and digestive organs when speaking of the symptoms and treatment 
of spermatorrhoea. 

The cases which I have related — few in number, but circum- 
stantial and varied — are sufficient to give an idea of the principal 
abuses of which the generative organs are the seat^ and of the 
manner in which such abuses bring about more or less serious and 
resisting spermatorrhoea. Of all the causes capable of producing 
this unfortunate result, none is, at present, more common. I ought, 
perhaps, only to consider here the mode by which abuses act in 
producing spermatorrhoea, such being the object of this chapter; 
but the complicated chain of circumstances attaching to the subject, 
forbids this ; and I must ascend by degrees to the causes of the 
abuses, in order that they may be avoided, or at least, that their 
danger may be diminished. Of such an occurrence it is especially 
of importance to prevent the evil, inasmuch as, when once esta- 
blished, it is occasionally without remedy, and generally leaves its 
traces during the rest of the patient's life. There is, perhaps, no 
single question of more importance to the happiness of families, or 
to the welfare of society, than this. In order, then, to examine the 
numerous facts I have collected in their proper order, I shall first 
speak briefly of the causes of abuse. 

Causes of Abuse. — These may be divided into two classes: — 
First, causes inherent in man, or those acting from within ; these 
may be considered as predisposing causes; secondly, external 



ABUSE. 143 

causes, or those arising from accidental circumstances; and these 
may be considered as exciting causes. 

Internal or Predisposing Causes. — Of the first class of causes, the 
most important is undoubtedly due to the human organization. In 
the lower animals the male and female live together, as if there 
were no difference of sex, except during the short rutting season.,. 
This period passed, perfect calm is restored. In the human species, 
the secretion of semen constantly goes on, from the time of maturity 
until extreme old age; the secretion may indeed be increased or 
diminished by excitement or repose of the organs, but, during this 
period, it is never entirely suspended as long as the secreting tissues 
are healthy. Still, this universal and important fact has been much 
neglected: its application is evident. 

The form of the superior extremities in the human race also 
possesses considerable influence in predisposing to abuse. Many 
animals are always fit for fecundation — spermatozoa being found in 
them at all seasons. They are, however, unable to excite seminal 
emissions without the aid of the female. Other animals, again, 
which, during the rutting season, show an almost incredible amount 
of erotic fury, are still unable, by their own actions, to cause sper- 
matic discharge; their form alone prevents this, for they often 
attempt it, and a few even succeed. It is well known with what 
fury apes are addicted to masturbation ; the ape being, of all the 
lower animals, the nearest to man in form. 

To this original disposition, more perfect in man than in any other 
animal, must be added the influence of pathological causes. I 
have already spoken of the irritation caused by ascarides in the rec- 
tum, of the erections they excite, and of the abuses induced by them. 
We shall see by and by, that herpetic eruptions on the penis and 
prepuce may produce the same effects, and I shall show, also, that 
an accumulation of sebaceous matter, between the prepuce and glans 
may have a similar influence. I must also mention irritation of the 
cerebellum, as inducing serious abuses, of which I shall give cases 
in their proper place. 

There is even some connexion between the organs of generation 
and distant diseases; for Dr. Desportes has mentioned a kind of 
angina, which is frequently preceded by a considerable increase in 
the venereal desires, and, consequently, by a disposition to all kinds 
of abuses. 

Pulmonary phthisis, also, is often attended by considerable vene- 
real excitement. It may as well, then, be at once admitted, that 
causes predisposing to masturbation exist in the human organiza- 
tion itself. 

External or exciting Causes. — Of these, I shall lay particular stress 
oh such as act before puberty, because they have, hitherto, attracted 
very little attention. The most anxious parents believe that there is 
no occasion to watch over the actions of their children with regard to 
their genital organs, previously to the epoch of puberty; and few, 



144 CAUSES OF SPERMATORRHEA. 

even of our own profession, are led to suspect bad habits before that 
period. This is a fatal error, against which it is necessary to be on 
our guard : numerous causes may give rise to abuses, at a much ear- 
lier period — infancy being hardly exempt from them. I saw one 
unfortunate child, which, while still at the breast, nearly fell a victim 
to the stupidity of its nurse. She had remarked, that handling the 
genital organs appeased its cries, and induced sleep more easily than 
any other means, and she repeated these manoeuvres, without noticing 
that the sleep was preceded by spasmodic movements. These 
increased, and took on a convulsive character, and the child was 
losing flesh rapidly, and becoming daily more* irritable, when I was 
consulted. At first I attributed the disorder to worms, teething, &c, 
but my attention being attracted by certain signs, I examined the 
genital organs, and found the penis erect. I was soon told all, for 
the nurse had no idea she was doing wrong. It was necessary to 
dismiss her, for her presence alone sufficed to recall to the child's 
memory sensations which had already become a habit. Time and 
strict watching were required before these early impressions were 
entirely effaced. Dr. Deslandes relates two similar cases, and Pro- 
fessor Halle, in his lectures on hygiene, used to mention many such ; 
Chaussier, too, has told me of several that came under his notice ; and 
both these observers believed such cases to be less rare than they are 
usually considered. These manoeuvres quiet the children very rea- 
dily, and nurses always endeavour to obtain quiet at any sacrifice ; 
they have no idea of the consequences of their conduct. At a later 
period, children are exposed to the same dangers, on the part of the 
servants having charge of them ; and in these cases, it is not of igno- 
rance that the attendants are to be accused. Many patients have 
consulted me, who owed their disorders to this cause ; and in case 
61, 1 have shown the influence which such early abuse exerts on after 
life. In some children there is a kind of precocity of sexual instinct, 
which leads to very serious results. In these, it often happens that 
the sexual instinct arises long before puberty; such children manifest 
an instinctive attraction towards the female sex, which they show by 
constantly spying after their nurses, chambermaids, &c. These freaks 
of children are usually laughed at, but if they were regarded with 
more attention, it would become evident that the sexual impulse has 
been already awakened. Rousseau, in his confessions, has well 
described the influence which early sexual impulse exercised on his 
whole life, and I have received numerous confidences of the same 
nature which, however, it would be of no service to relate here. 
One case, however, is so remarkable, that an abstract of it may be 

instructive. M. D , the son of a distinguished physician, between 

five and six years of age, was one day in summer in the room of a 
dressmaker, who lived in his family : this girl, thinking that she might 
safely put herself at her ease before such a child, threw herself on her 

oed, almost without clothing. The little D had followed all her 

motions, and regarded her figure with a greedy eye. He approached 



ABUSE. 145 

her on the bed, as if to sleep, hut he soon became so bold in his be- 
haviour, that after having laughed at him for some time, the girl was 
obliged to put him out of the room. This girl's simple imprudence 
produced such an impression on the child, that when he consulted 
me, forty years afterwards, he had not forgotten a single circumstance 
connected with it. 

The continual occupation of his mind by lascivious ideas did not 
produce any immediate effect, but about the age of eight, the most 
insignificant occurrence served to turn his recollections to his destruc- 
tion. Having mounted one day on one of the moveable frames 
which are used for brushing coats, he slid down the stem which 
supports the transverse bar, and the friction occasioned caused him 
to experience an agreeable sensation in his genital organs. He 
hastened to remount, and to slide down in the same manner, until 
the repetition of these frictions produced effects which he had been far 
from anticipating. This discovery, added to the ideas constantly 
before him, gave rise to the most extraordinary abuses, and, after a 
time, to excessive masturbation. 

I need not mention all the miseries which followed this fatal pas- 
sion ; it will be sufficient for me to relate the means to which he had 
recourse for its correction. He slept on a very hard bed without a 
shirt, in order to avoid all friction, and covered by a single coverlet 
sustained by a cradle : his arms were raised, and crossed above his 
head ; a servant remained by his side during the night, with orders to 
awake him if he changed his position. When he got up, he put on, 
next his skin, a shirt of mail weighing twenty-two pounds, resembling 
those worn by the knights of old, except that it had no sleeves, and 
that it was attached, at its lower extremity, to a silver basin, fitted to 
receive the genital organs, and provided with openings for the thighs. 
This shirt of mail was open in front, in order to be easily put on and 
taken off; and when on, it was laced up with a steel chain, a padlock 
being attached to the end, the key of which was kept by the servant, 
who had orders not to give it up on any pretence whatsoever. Guarded 
by the silver basin, the genital organs were completely removed from 
the touch, a little opening only, being left for the discharge of the 
urine. As a still greater precaution, the patient had caused four 
sharp points to be fixed in front of this case, in order directly to op- 
pose any erection. This apparatus he continued to wear for nine or 
ten years, although it frequently caused inflammation of the testicles 
and spermatic cord, by its pressure. Notwithstanding all these pre- 
cautions, the patient's moral and physical condition were deplorable, 
which led me to suspect the presence of diurnal pollutions. 

I should observe, that in all the cases of which I have just spoken, 
the children were five or six years of age— at most eight — that they 
did not show signs of puberty for several years afterwards, and that 
they were not exposed to the influence of bad example. Their sexual 
ideas were, therefore, spontaneously developed, several years before 
the development of the genital organs. The same precocity is often 



146 CAUSES OF SPERM ATORRHCEA. 

observed in children of the other sex. Of this I shall treat more fully 
hereafter; at present, I shall merely call attention to the case related 
by Parent Du Chatelet,* of a little girl, who, from the age of four 
years, gave herself up to the most unbridled abuses. 

From these facts an important scientific conclusion may be deduced : 
— viz., that in many children the genital instinct shows itself with 
much energy many years before the age of puberty. 

A no less important practical precaution presents itself: — viz., 
that the age of puberty should not be waited for, in order to sur- 
round children with prudent circumspection, and to prevent their 
curiosity from being gratified. 

Many parents are remarkably careless on the latter point ; they per- 
mit children of both sexes to play together, promiscuously, for hours, 
without any surveillance, provided that they are removed from all 
danger of accident, and that their noise is not annoying. The confi- 
dence of many parents, also, in the ignorance of their children, makes 
them careless of the marks of familiarity which are given to each 
other in their presence ; children's sleep is not always so real or so 
sound as it seems. 

It is sufficient to point out these facts : every person can deduce the 
conclusiens ; and now I hasten to consider a question, the gravity of 
which has been allowed by all who have written respecting mastur- 
bation — I mean the influence of example in educational establish- 
ments. 

If I may judge from my own observations, out often persons whose 
health has been deranged immediately or remotely from the effects of 
masturbation, nine first contracted the habit at school. All that I 
have read on the subject has led me to conclude that this proportion 
is not exaggerated. A child brought up in the bosom of his family 
is, it is true, surrounded by many causes sufficient to arouse his curi- 
osity and excite his imagination ; but such causes act accidentally, 
and in an isolated manner — they only produce a serious effect on a 
few ardent imaginations ; a thousand circumstances may remove the 
attention from them. At school it is admitted that such causes 
do not exist, but there are others, less numerous and less varied, but 
which operate in a much more active and continuous manner ; the 
effects of these are direct, and almost inevitable. The child finds, 
on his first arrival, a focus of contagion, which soon spreads itself 
around him ; the vice is established endemically, and is transmitted 
from the old pupils to those newly arriving. If a few privileged indi- 
viduals escape being initiated, they are only such as do not experi- 
ence any gratification. But their time will come at a later period; 
when the passions make themselves felt, the same circumstances will 
be presented to the mind, under a less disgusting aspect. I shall not 



* Annales d'Hygiene publique et de m6decine legale, torn. vij. Ire Partie, 1832, 
pag. 173. 



ABUSE. 147 

enter into details on this subject; but from all that has come to my 
knowledge, from various and direct sources of information, I do not 
hesitate to affirm, that nowhere are obscene books circulated more 
freely and boldly, than in educational establishments; that the origin 
of the vice is not solely in the scholars, but also in the ushers and 
servants ; that the abuses are not always confined to masturbation ; 
and that they are not always propagated by example or persuasion, 
but are sometimes enforced by threats and violence. Let it not be 
thought that I am now speaking of rare and exceptional cases, or 
that I exaggerate j 1 I possess multiplied and convincing proofs of my 
assertions. I would not, either, that I should be misunderstood. I 
am far from denying the advantages of education in a public school ; 
and I am ready to admit that the competition among a number of 
children produces emulation, forms the future character, early shows 
each his own value, and lays the foundation of friendships which en- 
dure through life. 2 

A too sedentary life is injurious at all ages, especially in childhood, 
when there exists such constant desire for exercise and change. 
Gymnastics, therefore, should on this account alone occupy an im- 
portant position in the system of education; but they must be viewed 
under a much more serious aspect. Nothing can prevent the genital 
organs, at the time of their development, from reacting on the eco- 
nomy and giving rise to new sensations and ideas. It is impossible 
to prevent the attention from being attracted by the impressions caused 
by these organs ; impossible to restrain the imagination and to pre- 
vent it from frequently dwelling on such impressions. The slightest 
circumstances may, in such a case, lead to a fatal discovery, even if 
the information be not transmitted directly, and enforced by example. 
How are such discoveries to be prevented, or rather, how are their 
results to be guarded against? Study gives us no aid here; indeed, 
the continued sitting necessarily heats the organs already too excited. 
The eyes may be fixed on the book, the ears may appear to listen to 
the master, but who can guard against the wandering of the imagina- 
tion? At night it is still worse; no surveillance can prevent this. 
There exists only one means capable of counteracting it, and that is, 



1 M. Lallemand of course speaks of the colleges and private schools in France. I 
regret to say that his statements apply with nearly the whole of their force to the 
schools of England. Vice is common in them, neglect of phj^sical education and the 
contracted nature of the studies to which pupils are confined in our classical semina- 
ries — the understanding being unappealed to, and the reasoning faculties unexercised 
— the natural sciences neglected, and the whole of the pupil's life until the age of 
seventeen employed in the study of the dead languages — are matters of vital impor- 
tance to which society has only recently begun to direct its attention. [H. J. McD. ] 

3 M. Lallemand enters very fully on the subject of education as conducted in France, 
and well exposes the errors of the system. Most of his remarks apply to our own 
educational system, yet, as the subject is not strictly medical, and as, moreover, M. 
Lallemand has treated it at considerable length, I think it best to refer those of my 
readers who may wish information on it to the original work. Vol. I. pas;e d25. 
[H. J. McD.] 



148 CAUSES OF SPERMATORRHEA. 

muscular exercise carried so far as to induce fatigue. This alone 
is able to deaden the susceptibility of the newly acting organs which 
excite the economy; exercise alone, by requiring matter for the re- 
pair of the muscular waste it causes, withdraws a stimulus from the 
genital organs, and induces sound and refreshing sleep. 

Varieties of Abuse. — I think it will be useful for me to give a 
few details, respecting the different kinds of abuse which have come 
under my notice, and of which I have seen the hurtful influence on 
the genital organs. I shall omit all such remarks as have not a 
strictly practical bearing. 

We have already seen the dangers to which compression of the 
urethra, to prevent the discharge of semen during ejaculation, may 
give rise (case thirty-five.) In the case I have related, it seems likely 
that a rupture took place in the mucous membrane, because the 
patient felt, at the instant, an acute pain, and the following day a 
discharge commenced, which continued until the application of the 
nitrate of silver. Soon after the commencement of the discharge, 
involuntary seminal emissions occurred, attended with serious symp- 
toms. It was immediately behind the glans that this patient com- 
pressed the urethra, and it is quite conceivable that the sudden and 
violent distention of the canal might cause a tear in the mucous 
membrane. But this is not always the case; one of my patients 
writes as follows : — "At the age of fourteen I practised masturbation 
three or four times a week, and sometimes frequently during the day. 
In order to prevent the discharge of semen, I compressed the root 
of the penis firmly. Nothing escaped at the time, but I soon ob- 
served that the semen was discharged with my urine, the first time I 
passed it. I followed this practice for about two years." 

Diurnal pollutions soon appeared, and grew more and more serious. 
The remainder of the case presents nothing which is not met with in 
all cases of spermatorrhoea. What I wish to call attention to here, 
is, that the compression was made close to the orifice of the ejaculatory 
ducts, and that the patient thought at first that his manoeuvres were 
not followed by any loss of semen, although he at length discovered 
the contrary. Fournier and Begin report a similar case. 1 It was that 
of a young man who, at the moment of ejaculation, compressed the 
most remote parts of the urethra, so that not a single drop of semen 
could escape. Yet the result was the same as in ordinary cases. 
Notwithstanding his precautions, his strength diminished, and his 
disorder made just as rapid progress as if the seminal emission had 
been perfect. 

The following is even a more remarkable case. I shall allow the 
patient to speak for himself. "1 am thirty-two years of age, and I 
have had nocturnal pollutions from the age of fourteen ; I have also 
suffered from discharges while at stool, for ten years. The cause of 
these pollutions cannot be referred to masturbation, for I have not 

Dictionnaire des Sciences Medicates, Art. Masturbation, page 125. 



ABUSE.. 149 

practised it twenty times during my whole life. The pollutions are 
rather owing to reading obscene books, for they commenced soon 
after. At first, ejaculation was preceded by dreams, and accompa- 
nied by active erections and acute sensations, the semen being ejacu- 
lated with force. I tried various means to prevent these discharges. 
I have slept, during whole nights, with my penis dipped in cold 
water, or compressed between two pieces of wood formed on purpose. 
I have tried to keep myself awake in order to prevent an emission, 
because, when I succeeded, the following day I felt stronger, but 
after two or three nights, sleep always overpowered me ; I often 
awoke, however, in sufficient time to prevent the catastrophe of my 
dreams, but frequently it was too late ; on such occasions, to delay 
the discharge or to render it less copious, I compressed the base of 
the penis firmly; but it seems that these compressions greatly injured 
the parts, without preventing or diminishing the discharge, which 
took place inwardly, as I have often been convinced by inspecting 
my urine. From that period the pollutions have no longer been pre- 
ceded by dreams; and the sensations have left me, so that I am not 
now aroused from sleep. My erections diminished, and have even, 
latterly, ceased entirely. For three years erections have rarely ac- 
companied the emissions; when they do occur I am always less 
fatigued. 

" There is one thing which I have not been able to understand, 
and which will, without doubt, appear absurd to you; it is, that I 
experience pollutions without erection, sensation, or the escape of 
semen by the urethra. I believe that the discharge passes in a retro- 
grade direction, and becomes mixed with urine, because, the next 
morning, I find little globules, a cloud and filaments, in that fluid, 
just as when I formerly prevented ejaculation by compressing the 
root of the penis ; whilst my urine contains nothing during the day, 
or the next morning when I have not experienced these pollutions. 
On waking, I am perfectly aware of what has occurred, by the sweat 
that covers my face, the fatigue I feel in all my limbs, the headache 
and dazzling that affect me, the dark circles that surround my eyes, 
&c. I have tried cold and iced applications, with slight benefit. 
For some time the pollutions were rarer, and were accompanied with 
erection and sensation; but soon they became as before, and emission 
did not take place outwardly. These internal pollutions have always 
been the most weakening. Whenever I succeed in passing the night 
without sleep, my urine is transparent in the morning, and I feel 
strong. After several nights without sleep, I generally have an ener- 
getic emission, which fatigues me little; but soon those without erec- 
tion and without external discharge return, and then I always feel 
worn out on waking." 

This patient's medical attendant would not believe in the possi- 
bility of pollution without external discharge ; but it seems clear that 
the patient really had internal emissions without perceptible dis- 
charge ; that is to say, that the semen passed into the bladder, and was 



150 CAUSES OF SPERMATORRHOEA. 






discharged with the urine, as had occurred before when ejaculation was 
prevented by pressure on the perineum. This compression was made . 
in front of the ejaculatorj canals, and was very often repeated. It 
seems, therefore, likely that it was the frequent repetition of these 
manoeuvres that, at length, caused the spontaneous passage of the 
semen into the bladder. But this is a question to which I shall have 
occasion to return. 

Yet all these manoeuvres scarcely differ from the various means 
recommended by some surgeons for preventing nocturnal pollutions ; 
and we may thus perceive how little confidence is to be placed in the 
instruments invented for that purpose, and the inconveniences to 
which they may give rise. It seems likely that the dangers would 
be nearly the same, in whatever part of the penis the compression is 
made ; except that if there be sufficient space in the urethra, between 
the point compressed and the ejaculatory ducts, to contain all the 
semen, it would be discharged directly the compression is removed. 
When, on the other hand, the compression is made immediately in 
front of the orifice of the ejaculatory ducts, the semen flows back, at 
least, in great measure, so as to induce the patient to believe that the 
discharge has been stopped, or at all events, in great measure 
diminished, and to induce a degree of security which leads to further 
abuses. 

But to return to the description of the abuses which have been 
admitted to me by so many other patients. 

One of these informed me, that about the period of puberty, while 
hanging one day by his arm, he experienced an energetic erection 
accompanied with pleasure, and that by his efforts to raise his body, 
he caused an abundant seminal emission. This was the first. The 
next day he repeated the same motions, and noticed the same phe- 
nomena, and from that time he knew no other pleasure. From the 
principles which had been early instilled into him, he would have 
thought himself degraded by connexion with a female, or by the least 
manual contact with his genital organs ; but his conscience was quiet 
with regard to these practices, because they had not been forbidden 
him. He continued, therefore, to hang by the hands, from the furni- 
ture, doors, &c, without being suspected by any one, and fell, by 
degrees, into a state of debility and wasting equal to those caused 
by the most unbridled masturbation. After a time, from weakness, 
the patient lost the power of hanging, and his voluntary emissions 
ceased; but they were soon replaced by nocturnal emissions, which 
were very difficult of cure. 

The following are a few passages from a letter I have recently 
received. " Being of an ardent temperament, I abused myself, from 
the age of eight years, by practising masturbation, or rather, by still 
more hurtful manoeuvres. By compressing the penis between my 
legs, or against the seat on which I was sitting, I produced excite- 
ment, which was commonly followed by the discharge of a few drops 
of a viscid and transparent fluid. This practice I repeated several 



ABUSE. 151 

times a day, up to the age of sixteen, when I ceased entirely, having 
been frightened by the discharge of nearly pure blood, which occurred 
several times. From this time I only sought natural enjoyments, but 
I found it impossible to obtain a complete erection. This state was 
attributed to weakness, and was combated by tonics, stimulants, and 
even irritants of all kinds, which have done me much injury. I used, 
also, cold bathing and cold lotions." 

I have seen an officer of high rank who had fallen into the same 
condition, from the practice of similar manoeuvres. He experienced 
his first sensation against the leg of a table, at the early age of ten 
years, and continued for several years to employ the same means. I 
have already related the case of another child, who allowed himself to 
slide down a wooden pole, and the deplorable influence which this 
circumstance exercised on the remainder of his life. 

In a few of my patients, horse exercise caused the first seminal 
emissions. I shall relate, by and by, the case of one of these who 
knew scarcely any other pleasure, and who became quite impotent at 
the age when virility is generally greatest. The extreme suscepti- 
bility which the genital organs manifest at the period of puberty, 
should prevent horse exercise from being commenced about this 
period, as is usually done. It should be begun a few years earlier, 
or a few years later. 

I have already spoken of the danger of allowing children to sleep 
on the abdomen, (see case thirty-three) I should add, that many of 
my patients thus contracted habits which ruined their health. Inde- 
pendently of the inconveniences to respiration, digestion, &c, which 
arise in this position, erections are favoured. The least friction 
awakens new sensations, and once on the track, progress is soon 
made. Sometimes recollections have caused the choice of this posi- 
tion ; of this I have related a remarkable example, (see case thirty- 
four) at other times, scruples early instilled by a sage foresight, but 
which the violence of the impulse has at length succeeded in eluding, 
have induced it. Thus, I have been told respecting one of my 
patients, that he would suffer death rather than defile himself by 
touching the genital organs, yet, for five or six years, he seldom 
passed a night without working his own destruction while lying on 
his abdomen. It is not necessary for me to enter into a description 
of the other means by which patients have sought to satisfy their 
genital impulses, without transgressing the religious and moral prin- 
ciples which had been taught them from infancy. Suffice it to say, 
that if they have succeeded in satisfying their consciences, they have 
not succeeded in preserving their health. 

But to abstain from all direct action on the genital organs, is not 
always sufficient to preserve the patient from serious disorders. A 
purely nervous excitement, awakened by the other senses, or directly 
produced by erotic ideas, may bring the same results as the worst 
abuses if prolonged or repeated erections are caused by it. The 
following are a few such examples: — 



152 CAUSES OF SPERMATORRHEA 



A student, aged twenty-two, born in Switzerland, of 
temperament, and great muscular power, fell into the most complete 
state of impotence, after having been for some time exposed to un- 
gratified excitement. He had never practised any solitary vice ; but 
violent and prolonged erections came on, and were produced during 
the day by the influence of the memory. These erections caused 
abundant and frequent nocturnal pollutions. Absence put an end to 
the excitement. The nocturnal pollutions diminished by degrees, and 
at length ceased entirely. Yet this patient fell into the same state of 
impotence as if he had committed the greatest excesses in masturba- 
tion, and at the same time preserved the appearances of health and 
strength. The cause of his impotence was evident on examining his 
urine, and causing him to watch for diurnal pollutions while at stool, 
but the cure of these pollutions was only perfect after two years' 
treatment. 

I have seen another case of the same kind, in a young man who 
passed from a state of habitual priapism to one of absolute impotence, 
without any other cause than violent excitement of the genital organs 
by an ardent attachment; he had never given way to excess of any 
kind. I shall record by and by another case of the same kind. I 
also had under my care an English officer, who left Calcutta in per- 
fect health and arrived in London completely impotent, after having 
suffered during two months from almost constant erections, excited 
by the presence of a female on board ship. This state, so opposed to 
that which had preceded it, continued for two years — the whole of 
this time not being marked by the least sign of virility. It is scarcely 
necessary to add, that this state was produced by diurnal pollutions. 

I related a case, a few pages back, (page 136) in which nocturnal 
pollutions were caused by reading an obscene book : I have seen a 
multitude of cases of this nature. From these I conclude, that in 
certain very excitable individuals, reading such works, the sight of 
voluptuous images, lascivious conversation, in a word, all things that 
can excite or keep up irritation in the spermatic organs are capable 
of producing the same effects as actual abuse, even when the will is 
sufficiently powerful to prevent the thoughts from leading to the acts. 
On the other hand, an abundant secretion of semen with importunate 
erections, irritation of the urethra and prostate, always results under 
such circumstances ; and these favour the occurrence of nocturnal and 
diurnal pollutions as serious, and perhaps more difficult of cure than 
those produced by masturbation, because it is impossible to act di- 
rectly on the memory or the imagination. 

It is not sufficient then to prevent all material action on the genital 
organs ; it is necessary also to prevent all erotic excitement of the 
senses and all concentration of the ideas on lascivious objects. For- 
tune's favours are so distributed that numbers live in absolute indo- 
lence without being blamed by the world, because they demand 
nothing of any one. This inaction produces results, the only remedy 
for which that I am aware of, is daily fatigue of the body by various 
kinds of exercise. 



ne 



ABUSE. 153 

Effects of Abuses. — The effects produced by the different kinds 
of abuse of which I have been treating, vary according to the age of 
the patient, his idiosyncrasy and the different organs chiefly affected. 
I have laid particular stress on the causes which may lead to bad 
habits some time before puberty; I must now consider their effects 
during this period. 

The symptoms arising from masturbation in the child have been 
always hitherto confounded with those produced in the adult; they 
present certain distinctive characters, however, which require our 
consideration. However young they may be, children lose flesh, and 
become pale, irritable, morose and passionate ; their sleep is short, 
disturbed, and broken. They fall into a state of marasm, and at 
length die, if not prevented from pursuing their courses. Examples 
of such a termination are so well known that I forbear to quote them. 

Analogous symptoms are shown in the adult — follow nearly the 
same course — and may lead to the same termination ; but in infancy 
more or less severe nervous symptoms are superadded, which are not 
found in those who have commenced the practice after puberty, or 
which at least are not in the latter case manifested to the same extent. 
Such are spasms and partial or general convulsions, eclampsia, epi- 
lepsy, and paralysis, accompanied with contraction of the limbs : these 
phenomena were present in all the children whose cases I have 
noticed, and numerous similar facts have been published by different 
authors. 

Contractions of the limbs have been well investigated by Dr. Guer- 
sent, 1 and he notices that they especially affect such children as are 
lank, unhealthy-looking, nervous and worn out by bad habits. 

The following case is sufficiently remarkable. In 1824 a woman 
brought her son, aged eight, to the hospital St. Eloi; he had lost 
the use of his lower extremities for some months. The limbs were 
fixed, and drawn together, and all the muscles contracted. The child 
was extremely thin, and his intellect was much disturbed. Mastur- 
bation, the cause of all these disorders, had only been discovered by 
his mother a few weeks before she placed him under my care, but she 
had used every means she could devise to prevent it, without effect. 
After two or three trials I found it was of no use trusting to the 
strait-waistcoats and other means usually employed, and accordingly 
I determined to pass a gum-elastic catheter into the bladder, and to 
fix it so that the patient should be unable to withdraw it. The pre- 
sence of the foreign body excited inflammation of the urethra, as I 
expected : when this occurred, I withdrew the instrument, but re- 
placed it as soon as the inflammation had subsided. I kept up, in 
this manner, a constant state of inflammation for a fortnight, which 
rendered the parts so painful that the child was unable to touch them. 
This treatment produced more decisive success than I had ventured 



Gazette Me'dicale de Paris, Fe'vrier, 1842. 



154 CAUSES OF SPERMATORRHEA. 






to hope; within eight days the lower extremities had regained suffi- 
cient strength and mobility to allow the child to get up, and in ano- 
ther fortnight he was able to run about the wards. I then sent him 
away, threatening him with a return of the same treatment if he re- 
lapsed. The pain caused by the catheter seemed to have removed 
all the other impressions, for his health continued good, and growth 
followed its ordinary course. 

I have since employed the same means in many cases, with just 
as much success, and I think it more sure than any other, because it 
is impossible to rely on the patient's will, or on the assiduity of those 
who are appointed to watch over him. In children too, it leaves an 
impression on the memory which is often sufficient to destroy the 
empire of habit, and to prevent a return to the former manoeuvres. 

But to resume the consideration of the symptoms observed in chil- 
dren. In childhood, seminal emissions are never experienced, but 
nevertheless the patients fall into a state of marasm, to which some 
even succumb. These effects, like those observed under the same 
circumstances in the female, have induced some authors to leave out 
of their consideration the seminal discharges which are produced by 
the same acts at a later period. They have attributed the debility 
which follows all abundant discharges of semen to the nervous ex- 
citement and convulsive motions, which usually accompany the dis- 
charge. The accidents observed before puberty are evidently only 
due to the effects on the nervous system; and, the same sensation 
accompanying voluntary emissions after puberty, it is natural to sup- 
pose that the nervous system plays as active a part then, as in child- 
hood. I willingly admit the importance of this nervous exhaustion, 
in whatever manner it may be supposed to operate; and supposing, 
even, that its action on the economy is just as important as during 
childhood, (which is not the case, as I shall presently show,) this is 
no reason why the actual discharges should not be taken into account, 
seeing that they greatly modify the character and consequences of 
the nervous disturbance. 

I have already noticed that the symptoms produced by abuses 
during childhood present a spasmodic character : this character, with- 
out doubt, is derived from the predominance of the nervous system 
at that period, rendering children so alive to external impressions. 
This excessive sensibility also explains the great disorder of the eco- 
nomy which children suffer from such manoeuvres. Deslandes 1 re- 
lates a case, showing that any action of the same kind may produce 
the same effects at this early age. He says : "An observer worthy of 
credit, Dr. Nurambeau, has communicated to me the case of a child 
who procured himself similar sensations by drawing out the navel. 
His health became much disordered from the effects of this strange 
habit, which had such a power over him that coercive measures were 



1 De I'Onanisme et des autres abus veneriens, page 462. 



ABUSE. 155 

required for its correction. It is worthy of remark that this patient 
showed neither erection, nor any other phenomenon of the generative 
organs, which at all referred to sexual intercourse." The organs of 
generation, therefore, had no influence in producing the sensations 
experienced by this child; but the repeated titillation of a very sensi- 
tive part produced the same disorder as masturbation. 

It was proved in the debates on a recent criminal trial that death 
may be caused by prolonged tickling the sole of the foot. Nervous 
disorder, arising from such proceedings, may then be carried so far 
as to cause death, and from this may be imagined the effects of the 
multiplied convulsive shocks which irritable children produce, by 
acting on the most sensitive organs in the economy. 

Every excessive loss of semen also, even when unaccompanied by 
sensation, is followed by debility, and this may be carried so far as to 
cause death; I have related several such cases in the beginning of 
this work. 

There exist, then, two distinct causes ; nervous disturbance and de- 
bilitating discharges, and both these act at once, when seminal emis- 
sions are produced by the influence of the will. It is not to be won- 
dered at, that both these causes should. produce nearly the same 
symptoms, because they both weaken the economy. The action of 
the first on the nervous system is direct and immediate, and the 
symptoms that result from it are of a more spasmodic character. It 
is very easy to confound these two causes when they act simultane- 
ously ; but I have just shown that they can be considered separately. 
The following reason shows the importance of so doing. 

Whenever we succeed in entirely putting a stop to the habits of 
abuse in children, we may make sure of obtaining their return to 
health, and that very quickly. This I have remarked in all the cases 
of children that have come under my care. I do not mean to infer 
that the disorder done to nutrition during the progress of development 
is easily repaired, but that the acute symptoms rapidly disappear, and 
that all the functions are quickly re-established. If the effects pro- 
duced are active and serious they cease very rapidly, as soon as the 
cause is removed, and return to health becomes certain. Unfortu- 
nately, matters do not follow so simple a course after puberty. 

What I have just said respecting children, applies equally to 
females : this is easily shown by examining the cases in which excision 
of the clitoris has been performed for the cure of nymphomania. The 
state of these unfortunates must have been deplorable indeed, to justify 
the resort to such means; yet they recovered very rapidly. 

Why in these two classes of cases, is the cure certain and the 
return to health rapid, as soon as the vice has been mastered ? It is 
that the cause of the weakness immediately ceases to act on the 
economy. Why is it that'so many men continue to waste away after 
they have entirely left off their habits of abuse ? It is because diurnal 
pollutions have commenced, which are even more debilitating than 
the abuses which gave rise to them. 



156 CAUSES OF SPERMATORRHOEA. 



Dr. Deslandes and many others have discovered that there is 
great difference in the conditions of persons who have practised 
masturbation for some time, and then renounced it; but they have 
not sought the explanation of this fact. It is, however, very im- 
portant to know why some are cured rapidly and completely, while 
others continue to suffer and languish during the remainder of their 
lives. The symptoms experienced by the latter are those produced 
by diurnal pollutions. 

But if we inquire why some should be affected by diurnal pollutions 
while others are exempt, we discover that we have been comparing 
two very different classes of patients. The one class conquered their 
bad habits by the force of their will ; the other class were compelled 
to renounce them by impotence. The former resisted their desires 
while they were yet active ; they required much perseverance and 
moral energy in order to succeed; the latter only left off as they were 
less tempted — the progressive decrease in their erections being due 
to the presence of undiscovered diurnal pollutions. 

Such patients deceive themselves as to the cause of their changing 
their habits, and are astonished at not finding any benefit arise from 
such change. Some of them even remark to their medical attendants 
that it is after they have left off their mal-practices that their health 
has become altered. 

All these circumstances, embarrassing at first sight, are easily ex- 
plained on a little reflection. At first the genital organs are healthy ; 
the constitution is uninjured; no seminal emissions occur except 
those that are induced voluntarily; and the activity of the digestive 
organs permits a rapid repair of the losses. But as soon as irritation 
is set up in the spermatic organs, a large quantity of semen is secreted 
and escapes every day, and several times a day, without the patient's 
knowledge; the digestion is disordered; the erections and voluptuous 
sensations diminish, because the semen is less perfectly formed ; the 
provocatives are therefore weakened by degrees, and the patient 
renounces, without difficulty, habits which only inspire him with dis- 
gust. He wonders that his health still continues to grow worse, for 
he has not discovered that he passes daily, by often repeated evacua- 
tions, more semen than he formely passed in a perceptible manner, 
and he does not take into account the difficulty felt by his economy 
of repairing these frequent discharges. 

We must not, then, confound those, whose virility leaves them, with 
those whom the power of their will causes to recover, and we must 
not be surprised at seeing the alteration in the habits of each followed 
by very different consequences. 

In order to make the distinctive characters of these two positions 
clear, I have laid stress on their most striking points, but there are 
numerous slight shades of distinction, which I have not mentioned. 
Eor instance, in some cases the two classes of phenomena occur suc- 
cessively in a very distinct manner, at very near periods. Many 
patients having corrected themselves once, find their health promptly 



i a 



ABUSE. 15T 

re-established. But when, after recovering their strength, thej have 
relapsed into their former habits, on renouncing them a second time 
they obtain no benefit. These different results under apparently 
similar circumstances can only be explained by the occurrence of 
diurnal pollutions in consequence of the return to habits of abuse. 

Case thirty-one is a clear and perfect proof of the correctness of 
this explanation ; the patient recovered twice after having twice con- 
quered his passion, but the third time he only gave it up through dis- 
gust, and his health continued to deteriorate until cauterization 
arrested the diurnal pollutions from which he suffered. 

There are many circumstances which interfere with the good reso- 
lutions of those addicted to masturbation. After a few days of abso- 
lute continence, attained with much difficulty, they frequently suffer 
from nocturnal pollutions, the more frequent and the more abundant 
in proportion as the spermatic organs have been much irritated : the 
patients always feel more debilitated by these involuntary discharges, 
than by those which they previously excited. Instead of combating 
these pollutions by suitable means, or after having employed one or two 
plans unsuccessfully, they think they will be able to diminish the evil 
by recurring to their former habits at distant intervals, and they thus 
relapse, increasing still more the irritation of the parts. Soon after 
diurnal pollutions commence, and rapidly produce their effects, but 
as these are not discovered, the patients rejoice to find the nocturnal 
discharges gradually disappearing. But their health daily grows 
worse : this they cannot comprehend, and are frequently led to ima- 
gine that they have mistaken the cause of their disorder. 

Sexual intercourse has been generally recommended in such cases, 
and sometimes with advantage ; but this means is like all others, the 
patient must be able to employ it, and even then it is necessary to 
distinguish the circumstances in which it is hurtful, from those in 
which it is advantageous. Very often the patients find intercourse 
impossible; while on the other hand, many of those who have been 
able to accomplish the act, have had an exacerbation of their symp- 
toms as the result. 

Whence arises this difference of result, in individuals placed in ap- 
parently similar circumstances? Some have diurnal pollutions kept 
up by the irritation of the organs, while others are exempt from them. 

All authors consider masturbation to be one of the most frequent 
causes of hypochondriasis, but the reason why this affection con- 
tinues so long after the patients have left off the habit has not been 
hitherto explained. If it only arose, as has been supposed, from 
weakness of the system, or disorder of the nervous functions, how is 
it that the various modes of treatment employed — the travelling, ex- 
ercise, and amusements of every kind, should produce no effects ? 
In every case of this nature that I have met with, I have found the 
hypochondriasis kept up by diurnal pollutions, which were unsus- 
pected by most of the patients ; the intellectual and moral faculties, 
together with the digestion, sleep, &c, improved in such patients in 



158 CAUSES OF SPERMATORRHEA. 

proportion as the pollutions diminished, and the return to health was 
complete as soon as they had entirely disappeared. The thirty- 
second case is a remarkable instance of this kind, and shows the 
strange monomania which accompanied hypochondriasis, as well as the 
rapidly beneficial effects derived from cauterization of the urethra. 
Many authors have noticed the indifference which persons addicted 
to masturbation show towards the opposite sex. This sentiment is, 
indeed, very common in those who have carried their abuses to a great 
extent; but I do not think it arises, as has been stated, from the long 
habit of solitary vice ; at all events, I can assign a more direct cause 
for this indifference, viz., the relative impotence of the patients ; I say 
relative impotence, because they possess sufficient power of erection to 
permit the practice of masturbation, but not enough to admit of sex- 
ual intercourse; and such patients seldom manifest any dislike to the 
opposite sex until they have experienced several disappointments, 
the remembrance of which constantly haunts them. Their views 
change immediately that the diurnal pollutions which kept up this im- 
potence are arrested. 

Effects of Temperament, Idiosyncrasy. Sre. — The effects of abuses 
vary much in their characters and intensity according to the indivi- 
duals attacked. Some persons are uninjured by the most unbridled 
abuses, even when long continued, whilst others are very quickly dis- 
ordered by slight abuse. In this respect I have witnessed very oppo- 
site cases with every variety of intermediate degree. 

Temperament seems to have little influence in producing this ine- 
quality of resistance. Strength or feebleness of constitution is not of 
so much importance as might be supposed. The very unequal power 
of the genital organs affords the only satisfactory explanation. I 
shall refer to this point more fully when treating of venereal excesses. 

Idiosyncrasy: in the same individual all the organs are not equally 
affected by abuse; this is shown by the frequent predominance of 
certain symptoms which give to the case a particular appearance, and 
are apt to lead to grave errors of diagnosis and treatment. I have 
related many cases in which this occurred. The presence of special 
symptoms, whenever a generally debilitating cause acts on the 
economy, arises from inequality of development, or of activity, exist- 
ing in certain organs. I shall, at present, only consider the direct 
and immediate action of abuses on the genital organs, so as to show 
the mode in which they produce nocturnal and diurnal pollutions. 

Urethral discharges. — Attacks of blennorrhagia are more frequent 
in persons addicted to masturbation, than is generally supposed. 
Cases of this kind have frequently fallen under my notice ; in the 
greater number of these patients the discharge was small in quantity, 
viscid, and nearly transparent, or very slightly coloured. It scarcely 
differed in appearance from the prostatic secretion. But in many 
patients the discharge was abundant, more or less coloured, and 
attended with pain in the urethra, especially during the passage of 
urine. Several suffered from all the symptoms of a contagious 



ABUSE. 159 

blennorrhagia; in others the same symptoms recurred two or three 
times, and in one patient the discharge reappeared as many as five 
times, always from the same cause. It is worthy of notice, that there 
existed a kind of intermittence in the habits of the last mentioned 
patients; after having been moderate or even quite continent for 
some time, they recommenced masturbation with fury, and the ure- 
thral discharges supervened on these relapses. Two of my other 
patients suffered from stricture of the urethra after one of these at- 
tacks of blennorrhagia, just as occurs after contagious blennorrhagia, 
and in one of these cases, the stricture was very tight and very dif- 
ficult of cure. 

I should remark, that I am now speaking of patients who had 
never had sexual intercourse, and that I leave out of the question 
such as had suffered from cutaneous affections, in which the urethral 
mucous membrane might have participated. I must add that thirteen 
of such patients had not reached the age of puberty when the dis- 
charges occurred. 

These discharges not having been excited by any virus or by any 
constitutional disposition, must be referred to the effects of mastur- 
bation. Many of them having occurred before the age of puberty, 
it is evident that they could not consist of semen. 

Prostatitis. — Several of my patients suffered from retention of 
urine after the most frightful abuses ; and it was necessary to relieve 
some of them with the catheter. In one patient an abscess formed 
in the prostate, and discharged through the perineum. 

Cystitis. — I have related many cases of acute and chronic cystitis 
of which masturbation was the sole cause. 

Emissions of blood. — Some of my patients had carried their passion 
so far as to provoke emissions of pure blood, or of semen mixed with 
blood. Authors contain many such cases, which show that the patho- 
logical condition of the urethra has extended itself to the lining of 
the seminal vesicles. Other patients suffered from more or less severe 
attacks of hematuria ; many experienced irritation of the bladder and 
kidneys, attended with an abundant secretion of bloody urine and 
constant desire to pass water; sometimes even micturition was in- 
voluntary. Thus the inflammation or irritation caused by mastur- 
bation, may, like that accompanying blennorrhagia, extend by de- 
grees, until it reaches the kidney. It will be easily believed that 
the irritation does not extend in this direction only. 

Orchitis. — I have seen several cases in which the patients suffered 
from acute attacks of orchitis, after furious masturbation ; and fre- 
quently such orchitis has required very active treatment for its relief. 
In one case the patient had not reached puberty when this occurred. 
In many such cases no doubt accessory circumstances existed, al- 
though the patients attributed the development of the orchitis only 
to masturbation. Others more slightly affected experienced pain in 
the testicles and spermatic cord, accompanied with swelling of the 
epididymis. Others, again, suffered a painful sense of tension. They 



160 CAUSES OF SPERMATORRHOEA 



felt as if the testicles were held in a vice or squeezed by a hand 
iron. In many, the least contact of the parts with the clothes was 
insupportable, and the weight of the testicles caused very severe 
dragging pain. In all such cases the patients were obliged to wear 
suspensory bandages, and often to guard the testicles from friction, 
with cotton, wool, or swansdown. 

These symptoms, which I have considered separately, generally 
occur together, and often form varying groups, which present special 
appearances, depending on the predominance of one of the symptoms. 
Sometimes the patients mention one circumstance only, because that 
one alone has attracted their attention ; but when questioned, they 
recollect many others which appeared trifling by the side of the more 
serious one. It is also important to remark, that diurnal pollutions 
generally follow very soon after the appearance of these symptoms, 
and that the patients are a long time without discovering them, and 
sometimes only detect them when taught what to expect. 

The more we reflect on these morbid phenomena, and the course 
of their appearance, the more striking is the resemblance between 
the effects of excessive masturbation, and those of blennorrhagia. I 
admit that the symptoms do not always present the characters of 
well marked inflammation, but they at least show those of active ir- 
ritation of the parts. It is easy enough to give a clear explanation 
of what passes in all cases of this kind, with perhaps some slight 
shades of difference. The testicles secrete more semen, which is im- 
perfectly formed; the seminal vesicles, participating in the state of 
irritation of the neighbouring organs, do not easily bear its presence ; 
they contract more readily, as they are more easily affected by ex- 
ternal impressions. Hence it becomes more and more difficult to 
avoid nocturnal pollutions ; after a little time diurnal pollutions oc- 
cur, and become more and more frequent and abundant; that is to 
say, there is a constant disposition in the seminal vesicles to contract 
spasmodically and expel their contents. 

On the other hand, the semen, ill-secreted by the testicles, and 
remaining a shorter time in its reservoirs, becomes thinner and more 
watery; and by degrees, as it loses its physiological characters, it 
also loses its normal properties; it becomes, therefore, unfit to pro- 
duce its effects on the seminal vesicles. The erections are conse- 
quently less energetic and less lasting, and after a time incomplete 
and fleeting; whilst in the end, in severe cases, they disappear al- 
together. Hence the embarrassment and timidity of such patients 
in the company of females, and the fear they experience of finding 
themselves in a position to expose their impotence ; and hence their 
indifference and even aversion for the sex, and the constantly in- 
creasing difficulty they experience in changing their habits. Such 
abuses, then, because their effects remain long after the habits have 
been altered, bring on symptoms, of which the cause is unsuspected. 
This is the reason why the health of some continues to deteriorate, 
whilst that of others is re-established as soon as they have renounced 



of 



VENEREAL EXCESSES. 161 

their mal-practices : this is why tonics, aphrodisiacs, cold bathing, 
and iced drinks, produce effects so different from those expected. 

There are undoubtedly cases in which the spermatic organs are 
weakened and relaxed; I shall relate several instances of this in a 
future chapter; but we shall then see that such a state arises from 
primary relaxation of habit and rather from want of use of the organs 
than from their abuse. 

In concluding my remarks on the subject of masturbation, I may 
observe, that it is the most dangerous of all vices of this nature, be- 
cause it is the most difficult to discover and to prevent, and because 
it does not require any assistance for its consummation. From the 
cases I have seen, I conclude that the irritation excited by such 
manoeuvres very easily induces involuntary discharges ; that the ap- 
pearance of nocturnal pollutions in those who attempt to abandon 
the vice often causes them to return to their former habits, and that the 
diminution of virility which follows, far from favouring the patient's 
amendment, frequently hinders it by proving an obstacle to their 
having sexual intercourse, while it does not prevent them from con- 
tinuing their bad practices. This circumstance is a powerful cause 
of the disorders which attend such as are reduced by vicious habits. 



CHAPTER VII. 



CAUSES OF SPERMATORRHEA. 



Venereal Excesses. 

I consider venereal excesses to consist of all sexual intercourse 
carried beyond the actual wants of the system. 

CASE XXXVI. 

Nervous temperament — Excessive intercourse at the age of ticenty-one, 
continued during eighteen months — Increasing derangement of health — 
Symptoms of gastritis, and of disease of the heart — Repeated abstrac- 
tion of blood — Nocturnal and afterwards diurnal pollutions; milk diet, 
&c. — Acupuncture followed by perfect recovery. 

Whilst in Paris, in 1822, I was called in consultation with MM. Dupuy- 
tren, Broussais, and Recamier, to consider the case of a young man who 
was supposed to be affected with cardiac disease, accompanied with chronic 
gastro-enteritis. We could not quite agree on the importance of the two 
orders of symptoms, but the indications appearing the same in each, a 
course of treatment and regimen was determined on, which I undertook to put 
into execution. Before proceeding, however, to repeat the abstraction 



162 CAUSES OF SPERMATORRHEA. 

of blood, which had already been practised several times, and from which the 
patient had never experienced relief, I questioned him further. My opinion 
respecting his disorder changed from the information I then received. The 
following are the facts : — 

M. E. B was short, thin, and very dark; of a nervous temperament, 

and an ardent and bold character. His parents were healthy : he had been 
early inured to exposure to the weather, and to the rudest exercise ; and 
by an active life had avoided all bad habits, as well as all commerce with 
women. 

At the age of twenty-one he married, and during eighteen months, carried 
sexual intercourse to excess. At first, all his functions became more active; 
he felt gayer, and more energetic ; and his appetite was much increased. 
But after a time, this excitement began to diminish, and by degrees gave 
place to the opposite state. His sleep was broken and unrefreshing; he felt 
heavy during the day, and his thoughts constantly wandered; his digestion 
became disordered, and he lost flesh as well as intellectual activity and mus- 
cular power. 

Intercourse being for a time prevented by the occurrence of pregnancy, 
these first symptoms disappeared, but they returned some months after de- 
livery, and from that time rapidly increased. The use of nutritive and 
abundant food, in place of repairing the patient's strength, increased his 
digestive disorder; stimulant drinks, taken with the intention of assisting 
digestion, only excited irritation; severe attacks of indigestion occurred, 
and brought on gastritis, which was combated by leeches to the epigastrium 
and anus. Obstinate constipation came on, and after a time was succeeded 
by diarrhoea. Feelings of suffocation next came on, with palpitations, which 
seemed to threaten disease of the heart. These symptoms were treated by 
further abstraction of blood. At the same time the patient's venereal 
desires grew weaker; his erections diminished; ejaculation took place more 
and more rapidly, and scarcely excited any sensation. The acts of coitus 
were several days apart, and sometimes did not take place for a week or fort- 
night. 

A second pregnancy afforded several months of absolute cessation from 
intercourse; but this time the patient did not regain his health. Nocturnal 
pollutions had commenced; these he regarded as the results of continence; 
but coitus, however rarely practised, always increased his weakness; the 
nocturnal pollutions diminished, and then disappeared entirely, but still the 
palpitation and digestive disorder continued to increase. The coincidence 
of these circumstances led the patient's suspicions from the true cause of 
his disorder. He attributed the inactivity of his genital organs to the ex- 
treme weakness of his system, which he thought arose from the leeching 
and diet he had been subjected to, and, consequently, omitted to speak of 
his impotence to his medical attendants, who, on the other hand, knowing 
that conjugal intimacy had ceased, did not inquire further. These symp- 
toms increased, until, at the age of twenty-five, the patient came to Paris. 
He had then suffered during three years. The following were the symp- 
toms : — 

Excessive emaciation and pallidity; considerable tenderness of the epi- 
gastrium; the abdomen constantly distended by flatus; tongue red at its 
borders, and towards the point; anorexia; digestion of animal food almost 
impossible, and that of vegetables difficult, and accompanied by flatulence 
and flushing of the face; obstinate constipation alternately with diarrhoea; 



VENEREAL EXCESSES. 163 

flatulent colic, often sufficiently alarming, returning at variable times, and 
without apparent cause. These colics commenced by rapid distention of 
the stomach with flatus, accompanied with spasm in its cardiac extremity, 
and in the large intestines, with oppression at the diaphragm threatening 
suffocation. The palpitations, together with the precordial anxiety, then 
became doubly severe, sudden congestion in the head took place, the shivering 
which had been present before gave place to a burning heat, followed by 
abundant perspiration ; after a longer or shorter time a sudden discharge of 
flatus occurred, both by the mouth and by the anus, which was followed by 
softening of the abdomen and immediate relief. The general prostration 
which followed these attacks was proportioned to their intensity and duration. 
At the same time the patient suffered from constant palpitation of the heart, 
increased by any exertion, by any excitement, physical or moral, and espe- 
cially by the process of digestion. The heart's action was rapid and irregular, 
but not stronger nor heard over a greater extent of the thorax than natural ; 
and there was neither friction sound, nor bruit de souffle. The pulse was 
small and weak. 

Besides these symptoms, the patient complained of general weakness, 
especially in the loins and legs, of a sense of lassitude, loss of memory, frequent 
sighing, irritability on slight contradiction, light, broken, unrefreshing sleep, 
and great sensibility to cold or damp.. 

These symptoms had been noticed by all the practitioners previously con- 
sulted. The following they had not discovered: — During the passage of 
the faeces, the emission by the urethra of a thick, viscid, unctuous, slightly 
opaque matter; frequent desire of micturition, the urine being passed in 
small quantities, and with little force, the last drops thick and viscid ; and 
after cooling, the urine being muddy and fetid, and depositing a flocculent, 
thick, whitish sediment; a feeling of uneasiness in the perineum, with pains 
in the spermatic cord and testicles, and spasmodic contraction between the 
sphincter and the neck of the bladder. 

After reflection on these symptoms, I did not hesitate to attribute them 
to involuntary seminal discharges ; and I accordingly prescribed iced milk 
mixed with lime water or spa water ; vegetable diet ; cold lotions on the 
perineum night and morning, and before and after defecation; an active 
country life, with often repeated exercise of short duration. 

On seeing the patient the following year, I found that these means had 
produced slight improvement, but that the progress towards recovery had 
been arrested for some time. I now, therefore, determined to try acupunc- 
ture. This I performed with two long needles, introduced about the middle 
of the perineum, so as to traverse the prostate in the direction of the ejacu- 
latory ducts. 

From this time the diurnal pollutions ceased almost suddenly; a few noc- 
turnal emissions then occurred, attended by dreams, energetic erections, 
and acute sensations; the sexual appetite returned, the patient's desires 
became imperious, and his re-establishment progressed rapidly. During six- 
teen years, M. B has since enjoyed the full activity of all his functions 

— the gastric and cardiac symptoms have disappeared, together with the 
diurnal pollutions. 

The lively interest which I took in this patient, made me discover, 
by dint of patient questioning, what had escaped the other practi- 
tioners he had consulted. At that time my attention had not been 



164 CAUSES OF SPERMATORRHEA. 

attracted to the effects of diurnal pollutions, which I had no idea were 
so common or capable of assuming so serious an aspect. This case 
struck me forcibly : indeed, I may say, that it in great measure en- 
lightened me as to the cause of a crowd of symptoms of the same 
nature, which I met with in other patients, and that it led me to 
make the researches which I now publish. 

In this case there was not the slightest complication. The first 
intercourse took place at twenty-one years of age ; the constitution 
was remarkably robust, and the genital organs had been preserved 
from all abuse : thus, the orgasm which seized them carried their ac- 
tivity to the highest degree, and all the economy was for some time 
in a state of active excitement ; all the functions were performed with 
more energy; the losses caused by the discharges were rapidly re- 
paired; and health continued in all its vigour. How then should 
danger be feared? The excesses were continued until the patient's 
health became disordered; and now, pregnancy having occurred, he 
had a period of rest, which caused these first accidents to disappear — 
showing they were only due to the venereal excesses. A second 
pregnancy, however, did not produce the same results — diurnal pol- 
lutions having already appeared. The local and general effects of 
these, with the errors of treatment that followed them, I need not 
comment on. 

Milk diet and exercise produced slight, but very slow improvement, 
which had entirely ceased when I saw the patient a year afterwards. 
The same results did not take place after acupuncture ; its action was 
rapid, and its results lasting. The spasmodic contractions experienced 
in the perineum, or rather between the bladder and rectum, that is to 
say, in the seminal vesicles, induced me to try this remedy. It struck 
me that these symptoms were purely nervous, and that habit had a 
good deal to do with their persistence. Success attended their trial, 
and the prompt action of the remedy can only be explained by the 
nervous disorder which it caused in the parts. Such a result made 
me hope much from the effects of acupuncture, in cases of spermator- 
rhoea, but it has succeeded in only a few; and by comparing the 
symptoms, the reason of this apparent anomaly is evident, seeing that, 
in most cases, diurnal pollutions are kept up by chronic inflammation, 
or acute irritation of the parts, and to remove this the operation has 
no power. Acupuncture too, does little good in cases of atony of the 
ejaculatory canals; so that there only remain such cases as are due 
to a purely nervous state, or a habit of spasm, and these are by far 
the least frequent. To these may be added cases in which the ner- 
vous disorder persists after the removal of the irritation, but these 
are still more rare. 

I have, at present, before me, the memoir of a master of a school, 
who married very young, after having resisted all temptation to bad 
habits, but who yielded, as in the preceding case, to immoderate in- 
tercourse, of which he soon felt the effects on his health. This patient 
took nutritive food to keep up his strength, and stimulant drinks to 



VENEREAL EXCESSES. 165 

assist his digestion. An attack of gastritis resulted, which was treated 
by leeches, baths, and vegetable diet. Two months passed in an 
excursion to the mountains, re-established his health, but on his re- 
turn he relapsed into the same state; constipation supervened, and 
his intellect was weakened. Three times, however, he obtained con- 
siderable benefit during the vacations, which he passed away from 
his wife, but at last, nocturnal pollutions commenced, and he was 
obliged to resign his occupation. This case resembles the one just 
related, except that the head and stomach were the organs chiefly 
affected. 

Simple cases like these are very common : they were even described 
by Hippocrates ; but, however common they may be, they are very 
serious, and of much importance to society generally. 



CASE XXXVIL 

Robust constitution — Venereal excesses continued till the age of twenty- 
four — Chronic Inflammation of the bladder — Nocturnal and diurnal 
pollutions — Cauterization followed by perfect recovery. 

Dr. D , short, dark, and robust, of a lively disposition, and much 

addicted to sexual intercourse, practised great excesses, which he some- 
times carried so far as to cause emission of blood. His health became 
disordered, his desires diminished, and at length ceased entirely. Notwith- 
standing absolute continence, his condition daily grew worse, and when he 
came to consult me, in 1832, at the age of twenty-five, he presented the 
following symptoms: great emaciation; face pale and sad; eyes sunken; 
urine passed from twenty to thirty times a-day, and its discharge attended 
by scalding and lancinating pains in the neck of the bladder, the stream 
small, weak, and crooked, and the last drops passed with difficulty, inducing 
spasmodic contractions of the neck of the bladder, and the expulsion of a 
thick viscid matter, which stopped at the orifice of the canal; the urine 
abundant in quantity, muddy, and sometimes containing blood, always de- 
composing rapidly, exhaling a disagreeable smell, and throwing down an 
abundant deposit of thick and flocculent matter; a feeling of weight in the 
rectum, and at the margin of the anus; spasmodic contraction of the sphinc- 
ters; habitual and obstinate constipation, notwithstanding the repeated use 
of lavements; defecation difficult and painful, and causing the expulsion, 
by the urethra, of more or less viscid matter resembling semen, (this was 
easily observed by emptying the bladder before going to stool;) the passage 
of flatus sometimes produced a similar evacuation, but less abundant; the 
nocturnal pollutions, frequent at first, had been rare during several months; 
pain in the testicles and spermatic cord, dimin'sliing by the use of a sus- 
pensory bandage; digestion difficult, and accompanied with the develop- 
ment of flatus, griping pains, and flushing of the face; loss of memory \ 
intellectual excitement producing headache, dizziness, and noise in the ears; 
restlessness, contrasting strongly with the weakness of the lower extremities; 
sleep unsound, and often broken by calls to micturate; lassitude greater in 
the morning than in the evening; catheterism very painful from excessive 
sensibility and spasmodic contraction in the neck of the bladder. 



166 CAUSES OF SPERMATORRHEA. 

From these symptoms I proposed cauterization, which was performed 
rapidly oyer the neck of the bladder, and more slowly over the mucous 
surface of the prostate; the pain was very severe, but diminished very 
quickly. The immediate effects of the operation presented nothing unusual ; 
long continued baths, abundant drinks, and repeated injections, sufficed to 
relieve the inflammation produced. From that time, I lost sight of Dr. 

D , until one day I met him accidentally; he was so changed, that I 

talked to him some time without recognition. His face was red and healthy- 
looking, his voice loud and sonorous, and he had grown stout to a degree 
uncommon at the age of twenty-seven; his return to health had been slow, 
but progressive, and was perfected without the use of any other treatment 
than the cauterization. He bore cold and damp with impunity, although, 
previously, he had always been very sensitive to them, and all his functions, 
without exception, were performed as well as before his illness. 

In this case, an affection of the urinary organs accompanied that of 
the spermatic, and the seminal vesicles were probably in a condition 
similar to that of the bladder ; indeed, the excesses had been several 
times carried so far as to cause emission of blood; abnormal irrita- 
bility existed in the prostatic portion of the urethra ; the spermatic 
cords and the testicles were the frequent seat of pain. The irritation, 
therefore, passed through the ejaculatory ducts and seminal vesicles 
to the spermatic cords and testicles. 

To this irritation the nocturnal and afterwards the diurnal pollu- 
tions must be attributed. The constipation, too, undoubtedly favoured 
the occurrence of pollutions during defecation ; but the constipation 
itself arose from the irritation in the prostatic region, as was indicated 
by the spasmodic contraction of the sphincters, and the sensation of 
weight in the neighbourhood of the rectum, and at the margin of the 
anus. All the symptoms disappeared after cauterization — another 
proof that they all arose from the same cause. 

In these two cases, venereal excesses acted alone in the production 
of spermatorrhoea. In the cases I am about to relate, such excesses 
were complicated with other causes. 



CASE XXXVIII. 

Three attacks of blennorrhagia — Hypochondriasis — Danger of suicide 
— Recovery — Marriage a few months after — Change in the moral 
facidties — Disordered digestion — Constipation — Agitation — Insomnia 
Fits of passion — Symptoms of mental derangement — Impotence — Noc- 
turnal and diurnal pollutions — Cauterization followed by rapid re- 
covery — Excesses repeated — Relapse. 

M. N — — , of strong constitution, and sanguineous temperament, passed 
his childhood without suffering from any disease, and attained a tall stature, 
and an unusual amount of strength. He rarely practised masturbation, and 
seldom had intercourse with women : at the age of twenty, he contracted 
blennorrhagia, which was cured in a month by the .use of copaiba. At the 
age of twenty -three, - he had a second attack, which was treated like the 



VENEKEAL EXCESSES. 167 

first, and cured in six weeks. At the age of thirty, a third attack occurred; 
this was treated by the same means, and cured in about the same time. 

From this period, M. N experienced frequent desire to make water, 

and only passed a small quantity at a time; his digestion became dis- 
ordered; constipation supervened; his venereal desires diminished; his 
sleep was disturbed and unquiet; and his character, previously very gay, 
completely changed. By degrees, he entirely separated himself from his 
friends; he sought solitude, and read only the most serious books. At 
length, he seemed pursued by an almost irresistible desire to commit suicide. 
His father having perceived this, took him to Paris, Switzerland, &c, in 
the hope that he would be benefited by change of scene; but whenever he 
passed over a bridge, or near a lake, or any precipitous place, he felt a desire 
to throw himself down. But these symptoms passed off by degrees, and at 

the end of six months, M. N resumed his duties as a notary, although 

he showed a somewhat dreamy air occasionally. Eighteen months afterwards 
he married, at the age of thirty-two. Sexual intercourse took place twice a- 
day for some time, but always very rapidly. At the end of three months, 

M. N experienced a great desire for motion and change, and considerable 

agitation. He sometimes showed an extraordinary degree of gaiety, but the 
least contradiction threw him into a terrible passion. His actions and his 
conversation had something strange about them. He even felt this himself, 
and frequently exclaimed, " Absurd! I am losing my senses; I am becoming 
a fool." His wife became pregnant, and afterwards suffered from peritonitis; 
hence a long suspension of intercourse took place, with remarkable improve- 
ment in M. N 's health. But after a few returns of intimacy, his diges- 
tion again became deranged, and his constipation returned and became more 
and more obstinate. A second pregnancy, by preventing intercourse, pro- 
duced the same results as the first. But on again resuming intimacy, an 
indefinable sense of uneasiness came on in the patient's abdomen, which was 
habitually distended with flatus; he frequently complained of cramps; of 
pressure on the chest; of difficulty of breathing, and palpitation. He felt 
suffocating; his head was hot ; his face red and injected; his mind disordered — 
he constantly repeated "that he was lost." At times he rolled about and 
tore his clothes, and when in these paroxysms, there was considerable diffi- 
culty in preventing him from doing himself injury, and from breaking every 
thing within his reach. Friction on the limbs and abdomen, and warmth, 
appeared to relieve the fits. When they were over, the patient shed tears in 
abundance, and shut himself up for a long time, without seeing any one. 
Such attacks became daily more frequent, and were sometimes repeated several 
times a-day. 

A remarkable change also occurred in M. N '& intellect; his memory 

and power of composition diminished, and he was obliged to give up his 
profession. His writing even became changed, and was almost illegible. 
He neglected music, previously his favourite amusement, and his voice lost 
its brilliancy and correctness of tone. He was generally taciturn, though 
sometimes he showed extraordinary loquaciousness, and his conversation 
was unconnected. Being unable to sleep, he rose often in the night, and 
walked about the room nearly naked, and if kept in bed by force, he tossed 
about, complained of suffocation, and demanded every minute what time it 
was. 

These symptoms seemed to point out a case of insanity. The patient 
was bled several times, and leeches were applied to the epigastrium and 



168 CAUSES OF SPERMATORRHEA. 






anus; but abstraction of blood only aggravated his condition. Injections 
did not relieve his constipation; five or six were sometimes necessary to pro- 
cure an evacuation. 

The patient's linen being constantly stained by semen, sometimes mixed 
with blood, his attention was attracted to the genital organs; and he soon 
discovered that he had frequent nocturnal pollutions, without erection or 
sensation. He immediately informed his medical attendant of this fact, and 
that gentleman further discovered the presence of diurnal pollutions, both 
while at stool and during the emission of urine. He accordingly sent M. 
N to consult me. 

I found the patient's urine thick and muddy, and containing a considera- 
ble deposit of semi-transparent granules, resembling grains of rice. I was 
unable to ascertain, certainly, the presence of seminal discharge during 
defecation, but nocturnal pollutions occurred almost every night; the dis- 
charge was very abundant, and often mixed with blood. On the 30th of 
December, therefore, I performed cauterization from the neck of the bladder 
as far as the membranous portion of the urethra. 

During five days, the urine was bloody; the patient's agitation was 
increased, and other accidents occurred, but from the sixth to the fifteenth 
clay these symptoms rapidly diminished. The stools became more regular; 
the urine transparent, and the patient's sleep sound and refreshing. Ene- 
mata were, from this time, no longer necessary; the patient's bowels acted 
freely every day; his appetite increased; digestion was rapid; and his 
sleep became daily longer and more deep; the patient hastened to bed at 
night, and rose late; he seemed to be in a state of narcotism from six at 
night till nine or ten in the morning. By degrees, however, this desire to 
sleep diminished; the patient rose early in the morning, walked all the day, 
and went into society in the evening; he wrote well expressed and sensible 
letters; his character resumed its gaiety; and he was tormented by venereal 
desires. 

Six weeks after the cauterization, all his functions were re-established; 
no discharge appeared in his urine ; the nocturnal pollutions no longer took 
place, and no pollutions occurred during defecation. On the 12th of February, 
the patient returned to his family. 

When M. N- quitted Montpellier his health was quite re-esta- 
blished : I dreaded his return to his wife, but I was obliged to yield 
to the impatience of his relatives, after having explained to them the 

origin of my fears. M. N himself promised the utmost reserve, 

and for a short time he kept his word; but he soon committed further 
excesses which the irritable state of his organs would not bear, and 
at the expiration of two months, a change again commenced in his 
character. The nocturnal pollutions reappeared, together with most 
of his former symptoms. Three months later, the patient again 
visited Montpellier. 

From the time of the cauterization, his stools had continued free 
and regular; his sleep had been sound; his appetite large; and his 
digestion regular. He daily took long walks. His condition, there- 
fore, was by no means so bad as at first; yet the nocturnal pollutions 
were repeated four or five times a week, and were very abundant; his 



VENEREAL EXCESSES. 169 

intellect was much disordered; and his speech was rendered difficult 
by a very decided stammering. 

I performed cauterization a second time, but its effects were 
neither so marked nor so lasting. The period for the mineral waters 
having arrived, I recommended the use of those at Aix in Savoy, 
both in baths and douches. I learnt afterwards, that these means 
were employed without success; and that the disorder of the pa- 
tient's intellect continued gradually to increase. 

This case much resembles that of M. De S , which I have 

related in my second chapter; page 37. 

I have before me the histories of many cases like the preceding; I 
shall not report them in detail, because they are less characteristic 
and less serious than that of M. N , and because I have, in a for- 
mer chapter, spoken of the influence exercised by blennorrhagia in 
producing irritation of the spermatic organs. The following is a 
summary of the chief symptoms presented by such patients as have 
come under my care : — 

After having had one or more attacks of blennorrhagia, more or 
less easily cured, the patients continued in good health so long as 
they contracted no permanent liaisons. In some of my patients, dis- 
ordered health caused such liaisons to be broken off, the health be- 
coming re-established by a prolonged continence ; after which, slight 
intercourse again caused an obstinate urethral discharge. After 
having led a regular life for some time, such patients believed them- 
selves sufficiently well to marry; but after a longer or shorter time, 
their health became deranged, although they did not think themselves 
committing excesses. By degrees, the intercourse became less fre- 
quent, the act very rapid, and after a time, quite impossible. 

In all these patients, the impotence was the result of diurnal pollu- 
tions which had been sometimes preceded by nocturnal pollutions. 
The diminution of virility is attributed, by such patients, to their dis- 
ordered health, to the regimen, or treatment employed to cure an at- 
tack of gastritis, of irritation in the chest, of palpitation, cerebral con- 
gestion, or of commencing disease of the medulla spinalis, according 
as such or such symptoms have predominated. Not only are the pa- 
tients ignorant that their state arises from diurnal pollutions, but I 
have even found it difficult, in many cases, to make them believe, 
that such is the case, because they have always thought themselves 
very moderate in their sexual intercourse. 

If these observations be compared with those related in my second 
chapter; and if the pain and swelling which these patients felt in the 
spermatic cord and testicles when they have not had severe attacks 
of orchitis following blennorrhagia, be taken into consideration; 
it will be evident that such inflammations may leave a particular sus- 
ceptibility in the mucous membrane of the genital organs, which only 
awaits an exciting cause for its development: that slight excitement 
from sexual intercourse, rather frequently repeated, may set up an 
irritation in the tissues which the same act would not have produced 



170 . CAUSES OF SPERMATORRHOEA. 

before the organs were thus affected; and lastly, that these tissues 
not being in the same condition, the individual must not reason from 
what he was able to do previously, to know whether he is com- 
mitting excesses, or whether he is still within the limits of his 
powers. 

It thus becomes evident, why the most serious and obstinate symp- 
toms are developed after marriage. 

I have already shown that masturbation may produce the same im- 
mediate effects on the spermatic organs as the most violent blennor- 
rhagia; I now proceed to show, that under similar circumstances, it 
may predispose to exactly similar remote results. 

CASE XXXIX. 

Strong constitution — Masturbation at the age of seventeen — Serious disorder 
of the health, until twenty-six — Marriage — Rapid improvement — Gradual 
relapse after three years, notioiihstanding the cessation of coitus — Seminal 
discharges during defecation and the emission of urine — Hypochondriasis 
— Inflammation of the genito-urinary organs— Cauterization — Rapid and 
complete cure. 

M. C , a land surveyor, of sanguineous temperament and large 

frame, practised masturbation with such fury that he brought on vomiting 
of blood, and became exceedingly weak, pale, sallow, and much emaciated. 
At the age of twenty his extreme weakness, notwithstanding his height 
and the size of his frame, made him reform after three unsuccessful attempts. 
He relapsed, however, and the same cause continuing, during six years his 
health was much disordered. At the age of twenty-six he married. 

During two years, intercourse took place daily, and frequently several 
times a-day, yet the patient's health improved rapidly, and his vigorous con- 
stitution reached all the development of which it was capable. 

In the course of the third year he perceived that his health became gra- 
dually disordered, and shortly after he noticed that he passed small quan- 
tities of semen while at stool. Soon the semen passed in larger quantities, 
and his health became more and more disordered. At length, obstinate 
constipation supervened, which rendered the seminal discharges still more 
abundant. They were accompanied with a slight, not unpleasant sensation. 

The patient experienced a constant itching in the scrotum and perineum, 
although there was no appearance of eruption, and felt a sort of creeping 
which extended towards the bladder and the root of the penis. His di- 
gestion was difficult, and attended by the development of flatus, and his 
stomach could only retain very light food, in very small quantities; his sleep 
was short, and disturbed by frightful dreams, and on waking he felt lassi- 
tude, soreness of his limbs and depression of spirits; during the day his 
thoughts were sad; — he presented, in fact, all the symptoms of confirmed 
hypochondriasis. 

He felt a constant desire to walk, but was soon tired; he bungled in his 
professional operations, lost his memory, and performed the most trifling cal- 
culations with difficulty. 

When M. C came to consult me in the beginning of August, 1824, 

he had relapsed into nearly the same condition as before his marriage. He 



VENEREAL EXCESSES. 171 

had, however, totally abstained from sexual intercourse for more than a year, 
because his venereal desires and erections had almost ceased. The orifice of 
the urethra was injected and irritable; the scrotum flaccid, and the testicles 
large but soft. The urine was passed often and with difficulty; the first jet 
requiring considerable efforts for its expulsion; the last drops caused spas- 
modic contractions in the bladder and neighbouring parts, and were thick 
and viscid, appearing like a thick solution of gum. The patient felt as if 
something always remained in his bladder. The urine was usually red and 
fetid, it deposited a thick flocculent cloud ; which was sometimes accompanied 
with glairy matter, like white of egg. 

These deposits I believed to contain semen, vesical mucus, and prostatic 
fluid, and their presence in the urine seemed due to chronic inflammation of 
the mucous membrane lining the prostate and neck of the bladder. The 
seminal discharges during defecation were more abundant than ever. These 
alone would have been quite sufficient to account for the patient's state. 

I proposed cauterization as the best means of altering the condition of 
the affected tissues; and the patient consented. On introducing the ca- 
theter I found the canal extremely sensitive; the spasms were so severe, 
especially on approaching the neck of the bladder, that the whole of M. 

C 's body was covered with a profuse sweat, and I found it necessary to 

delay the cauterization. Three days afterwards the same catheter was in- 
troduced with much less pain, and the urine having been completely eva- 
cuated I cauterized the bladder near its neck, and the prostatic and mem- 
branous portions of the urethra. The operation was performed rapidly, 
and scarcely gave more pain than the introduction of the catheter; but it 
caused a kind of very acute pinching pain at the margin of the anus and in 
the rectum. 

Soon after the operation the patient experienced a feeling of strength in 
the genito-urinary organs, which increased as the pain passed off. The con- 
stipation ceased spontaneously; the urine by degrees regained its colour and 
transparency, and at the end of the thirteen clays the patient was compelled 
to return home. The journey (about sixty miles) did not produce any of 
the inconveniences I had feared ; and two months afterwards I received a 

letter from M. C , stating that he was perfectly well, and had recovered 

his strength, and the perfect use of all his functions. 

This patient was not more moderate in sexual intercourse than he 
had previously been in his bad habits ; yet marriage benefited his 
health. This change, which lasted three years, shows the great dif- 
ference that exists between the effects of sexual intercourse and 
masturbation. 

Why did not this improvement continue ? Simply because the 
frequency of the acts exceeded the real wants of the patient ; and 
because the organs had previously been weakened by serious and 
long continued abuse. This circumstance is enough to show how 
complicated the important question of marriage becomes in such 
cases. I shall by and by relate some others which will perhaps make 
those pause and reflect, who thoughtlessly recommend so serious an 
engagement as a remedy for masturbation. 

Was there any semen in the urine in this case? The quantity of 
vesical mucus and of the prostatic secretion did not permit of a cer- 



172 CAUSES OF SPERMATORRHOEA. 

tain decision on this point. The last drops passed from the urethra 
were viscid, like solution of gum, and abundant seminal discharges 
took place during defecation. In cases of this nature it is evident 
that chronic inflammation extends from the mucous surface of the 
prostate to the neighbouring tissues; cauterization is a certain means 
of getting rid of this with all the symptoms depending on it. Whether 
there be or be not semen in the urine, the indication is always the 
same. 

I have more than once referred to the connexion that exists be- 
tween the neck of the bladder and the anus ; this patient showed it 
in a high degree. At the moment of the cauterization he complained 
of a severe pinching pain in the rectum and at the margin of the 
anus; and in proportion as the inflammation was dispersed, the 
sphincters became relaxed and the constipation ceased spontaneously. 

CASE XL. 

Sanguineous temperament — Masturbation from fourteen to eighteen years 
of age — Marriage at nineteen — Immediate improvement in the health — 
Afterwards, disorder of the system — Hypochondriasis — Inclination to sui- 
cide — Symptoms of chronic gastritis, treated for six years with leeches, 
blisters, &c. — Nocturnal and diurnal pollutions — Frequent discharge of 
urine — Cauterization followed by rapid and complete cure. 

M. C , of sanguineous temperament, and robust constitution, at the 

age of fourteen was five feet six inches in height, and of great muscular 
strength : at this time he contracted the habit of masturbation at school, and 
continued it till the age of eighteen. At nineteen he married, although he 
was very thin, and weakened by his previous abuses; but he regained his 
strength by degrees, and applied himself to agricultural pursuits with energy 
and success. He had two healthy children, the first years after his mar- 
riage. 

Nevertheless, although he had no cause for trouble, the patient's character 
changed by degrees. His gaiety and activity diminished, together with his 
strength and appetite. Sexual intercourse became less frequent. He suf- 
fered from nocturnal pollutions — rare at first, but afterwards more frequent. 
His stomach became disordered. He was constipated; his fseces were fre- 
quently streaked with blood, and during the straining necessary for their 
expulsion, he passed a considerable quantity of matter by the urethra, which 
he recognised as badly formed semen. He became careless, indolent, and 
timid; he neglected his affairs, and even the management of his farm. His 
affection for his wife and children diminished, and at length he fell into a 
profound state of hypochondriasis, and thought of nothing but his health. 

For six years, he was treated for a supposed gastritis, by the application 
of leeches, blisters, and issues; he was sent to the mineral waters, &c. He 
spoke of his seminal discharges to all the practitioners he consulted, but 
they were attributed to the gastritis, or his continence, even although he 
asserted that they were the cause of what he suffered. At length, at the 
age of thirty-five, he was sent to me by a young surgeon — one of his 
friends. He was then in a deplorable state of mind; his constipation was 



VENEREAL EXCESSES. 17S 

obstinate, notwithstanding the habitual and immoderate use of enemata: 
spermatic discharges occurred during defecation; micturition was repeated 
as often as fifteen or twenty times a day; the stream was feeble and broken-, 
and the excretion abundant and ]?ale, generally containing a flocculent de- 
posit. Nocturnal pollutions were frequent, and always occurred when the 
patient lay on his back, on which account he contrived a piece of wood to 
be fixed along the spine, to prevent him from assuming that posture, Ca- 
theterism was exceedingly painful. 

I cauterized the urethra from the neck of the bladder as far as the bulb, 
The ordinary immediate effects took place; at the end of eight days, the 
inflammation had nearly subsided, and the erections were violent and pro- 
longed without pollutions ; the patient's appetite returned ; his digestion im- 
proved; his constipation diminished; his sleep became sound and healthy; 
his strength increased; and the emission of urine became less frequent. 
Within a fortnight, his erections had become importunate during the day, 
and almost constant at night, attended with erotic dreams, but no pollu- 
tions occurred after the cauterization. Recovery of strength was rapid; 
and the desire of occupation and business returned. The patient went 
home on the twenty-second day. 

Four months afterwards, M. C wrote to ask me if he need go to 

the mineral waters as I had recommended him; he did not think it neces- 
sary, his health and strength being completely re-established. 

This case scarcely differs from the preceding; I shall, therefore, 
only call attention to the obstinacy with which the supposed gastritis 
was treated. It is difficult to form an idea of the tortures which this 
patient suffered during six years, or of the variety of means which 
were put in practice to combat his disease. Of these, abstraction of 
blood, by increasing his debility, and the application of blisters, by the 
action of the cantharides on the genito-urinary organs, did the patient 
most injury. * 

CASE XLL 

Nervous temperament — Delicate health — Masturbation before puberty— Ure- 
thral discharge after sexual intercourse — Orchitis — Nocturnal pollutions 
— Absolute impotence — Injections with solution of nitrate of silver unsuc- 
cessful — Cauterization followed by rapid cure. 

.M. S -, a doctor of medicine, short and thin, and of a nervous tempera- 
ment, was subject, from infancy, to various nervous diseases. He was 
addicted to masturbation long before puberty, which occurred at twelve 
years of age, and he continued the practice until the age of sixteen. At 
this period he had sexual intercourse, and after several weeks of daily con- 
nexion, an abundant discharge came on, which he neglected for a long- 
time. On returning to school, he felt pain in the right testicle, followed by 
acute inflammation, with considerable swelling of the spermatic cord. This 
was relieved by the usual means. The following year he experienced 
acute pain in the same situation, with a dragging sensation in the spermatic 
cord. These symptoms diminished by the use of a suspensory bandage, 
but the epididymis permanently acquired nearly double its normal size; 
the vas deferens continued very sensitive, and the urethra was irritable. 



174 CAUSES OF SPEEMATOEEHCEA. 

From that date, darting pains, accompanied with spasms, were felt in the 
prostatic region during micturition, especially whilst discharging the last 
drops. Sexual intercourse always left a sense of weight and heat in the 
organs. 

Before the occurrence of the urethral discharge, nocturnal pollutions had 
happened several times : these afterwards became more frequent, and after a 
time they took place without erection, emotion, or sensation. During two 
years, the patient's erections grew less frequent and daily more imperfect, 
and at length ceased altogether. 

M. S for a long time treated the pollutions by hygienic means alone; 

contrary to his expectations, he found that a very hard bed invariably pro- 
duced them, and that they were increased by any fatigue, especially by 
pedestrian exercise. He also found himself much worse after cold bathing. 
These circumstances made him suspect that the pollutions arose from a state 
of irritation. 

All his organs were almost equally debilitated; and all his functions were 
badly performed, and with difficulty; his sleep was broken and unrefreshing; 
his temper dull and irritable. The least serious occupation gave him head- 
ache, and a desire for change; slight exercise induced fatigue; his eyes were 
very weak and injected. 

On the 22d of February, 1836, the patient injected a solution of nitrate of 
silver (a quarter of a grain to the ounce,) into the urethra. About half the 
injection entered the bladder, and remained there for two hours. He passed 
a bad night, with acute pain, and had a pollution. On the 25th, he used 
another injection, stronger than the first; the same phenomena followed. 
On the 2d of March, he had another pollution. On the 6th, his urine was 
thick, fetid, sanguinolent, throwing down an abundant deposit and giving 
acute pain during its discharge. Thirty leeches were ordered to the hypo- 
gastrium, to be followed by a hot bath and emollient cataplasms. The 
symptoms diminished under this treatment. On the 24th of March, another 
pollution occurred, and from this date, they took place as often as before; 
complete impotence was established. In this condition, the patient came to 
consult me, at the age of twenty-three. His urine contained a white^deposit, 
which led me to suspect that he had diurnal pollutions. In the beginning 
of July, 1836, I applied the nitrate of silver from the neck of the bladder as 
far as the bulb of the urethra. The usual phenomena occurred. A fortnight 
afterwards, all the inflammation had disappeared, and re-establishment had 
commenced. Six months afterwards, I received the following note from M. 

S . " For five months my nocturnal pollutions have ceased — at least, I 

have only had one every ten days or fortnight, which appears inevitable, 
from my continued continence. My urine is perfectly transparent ; my tem- 
per is improved, and I study with pleasure, and without fatigue. My erec- 
tions have become frequent and long continued, which I fancy is the best 
proof of an absolute and permanent cure." By the use of sexual intercourse 
the patient's health continued to improve for two years, during which time I 
saw him frequently. 

This patient told me that he had not practised masturbation more 
frequently than his companions, but he had commenced long before 
puberty, and his constitution was naturally weak. He also asserted, 
that he had been moderate in his first intercourse with the other sex, 



VENEREAL EXCESSES. 175 

but his organs had been previously weakened by premature abuse. 
These circumstances account for the disastrous effects produced by 
so few connexions, so soon left off. 

A hard bed, cold bathing, and prolonged exercise, produced bad 
effects on this patient, which he explained correctly by referring the 
symptoms he experienced to a state of irritation of the organs, instead 
of one of atony. 

The mode in which the inflammation extended from the mucous 
membrane of the urethra to the spermatic organs is very evident in 
this case ; the painful spasm which was present in the neighbourhood 
of the prostate, the habitual irritability of the urethra and vas deferens, 
and the swelling of the epididymis, show clearly that the pollutions 
were maintained by a state of irritation. It is remarkable, that injec- 
tions with solution of nitrate of silver should have caused so much 
pain, and produced cystitis without any permanent benefit, whilst the 
nitrate, applied in substance to the disordered tissues, completely 
changed their action, without producing any untoward results. 

The cases I have related show at once how far masturbation may 
weaken the most active genital organs, at the period of their greatest 
energy, and the necessity of taking into consideration the actual con- 
dition of the parts, in order to appreciate the effects of sexual inter- 
course. 

I have so far shown that blennorrhagia and masturbation may leave 
a degree of irritation in the spermatic organs, or perhaps, a peculiar 
susceptibility easily increased by coitus. Hence it happens, that the 
virile power differs much, not only in different individuals, but in the 
same individuals at different periods. 

Independently of the changes which may occur before the act, the 
organs may be temporarily exposed to others just as hurtful. And I 
now proceed to point out, by two or three cases, the chief circumstances 
which may thus render coitus injurious. 



CASE XLII. 

Masturbation- — Venereal excesses — Prolonged horse exercise — Blennorrhagia 
— Nocturnal and diurnal pollutions — Two cauterizations — Recovery- 
Premature excesses — Relapse — Cure by another cauterization. 

M. T , of robust constitution, and bilio-sanguine temperament, con- 
tracted the habit of masturbation at school. At the age of fifteen, he cor- 
rected himself, but committed venereal excesses. Still his health did not 
undergo any notable change until some time after, when he was obliged to 
pass the greater part of the day, and often part of the night, on horseback. 
After several months of this kind of life, he felt weight and heat in the 
perineum, with pulsation and darting pain at the margin of the anus. 
Hemorrhoids appeared, and his sexual feelings diminished by degrees, and 
at length entirely left him. He detested the sex; and became morose, 
taciturn, and irritable; all his functions were disordered: he felt cast down, 



176 CAUSES OF SPERMATORRHEA 






careless, physically as well as morally depressed, and sought solitude. At 
length he commenced the study of medicine. 

A professor, whom he at first consulted, believed him afflicted with gas- 
tritis, afterwards with chronic enteritis; still later, he thought him hypo- 
chondriacal. In this condition, at the age of twenty-five, he consulted me. 
His symptoms were much the same as those I have related in so many 
other cases; but he had, in addition, a constant urethral discharge. 

I performed two cauterizations for this patient, six months intervening 
between them. The urethral discharge and diurnal pollutions disappeared 
completely; and his nocturnal pollutions became much rarer; he regained 
his embonpoint, and his former strength and activity. 

Unfortunately M. T yielded with little discretion to the venereal 

desires, which resumed their empire over him. A relapse resulted, requiring 
another cauterization, which produced the same effects as the former ones, 
although more slowly. His health was afterwards undisturbed by any 
similar accidents. 

The masturbation and venereal excesses which, in this case, pre- 
ceded the long continued horse exercise, must be taken into account; 
they certainly predisposed to the occurrence of blennorrhagia and 
nocturnal and diurnal pollutions. 

The mode of action of horse exercise on the genital organs is so 
evident, as not to require explanation. The fact is worthy of notice, 
because it explains the advantages or inconveniences of this exercise 
in cases of spermatorrhoea, according as they arise from atony or 
phlogosis of the spermatic organs. 

The excitement produced by horse exercise must also be noticed 
as a circumstance which may deceive the patient. The signs of 
virility which it excites are too often taken for natural desires. Even 
when these natural desires exist at the same time, they should not be 
satisfied while the organs are in a state of irritation and fatigue from 
riding, because the act itself tends to produce the same effects. 
Thus, the union of the two circumstances may produce more or less 
severe urethritis and its usual results. In the foregoing case, as in 
many others, I have seen irritation of the urethra accompanying the 
same state in the spermatic organs ; this is a very common coincidence, 
and one very easily explained. 

The relapse this patient suffered is worthy of notice on account of 
the difficulties which a convalescence from spermatorrhoea presents. 
Scarcely has the cure begun to progress, than the semen is retained 
longer in its reservoirs ; it is consequently better formed, the more 
fluid part being absorbed; hence frequent, energetic, and prolonged 
erections are excited. A time may arrive when these will become 
weakening and hurtful; the testicles continue to secrete, and the 
seminal vesicles have only a certain capacity ; evacuations must, 
therefore, take place ; if normal ones be prevented, they will occur 
abnormally, and the pollutions we are endeavouring to cure will re- 
appear. Hence moderate exercise of the organs is the best tonic in 



VENEREAL EXCESSES. 177 

this stage of the case. A return to the exercise of their functions is, 
therefore, beneficial — indeed, indispensable. It is difficult for the 
practitioner to point out the exact moment when such return should 
take place, and for the patient to prevent himself from overstepping 
the bounds of the most importunate necessity. Unfortunately the 
same thing occurs in these cases, that we see daily after other dis- 
eases — gastritis -for instance ; when a little food is allowed, an excess 
would recall all the irritation of the stomach ; but the patient often 
consults his appetite more than his power of digestion, and hence, 
disorder sometimes arises more severe than the first. In such cases, 
however, the meals may be watched, the food chosen, and the por- 
tions doled out. In the cases under consideration, such watching is 
impossible. 

CASE XLIII. 

Lymphatic temperament — Early and long continued masturbation — 
Horse exercise — Infrequent coitus — Urethritis — Repeated attacks of 
inflammation in the testicles — Frequent discharge of urine — Pollutions 
during defecation — Imperfect ejacidation — Two cauterizations followed 
by perfect recovery. 

Berthelot, set. twenty-three, of lymphatic temperament, the son of robust 
peasants, enjoyed perfect health during his infancy. Between the ages of 
ten and fourteen, he practised masturbation frequently with the other chil- 
dren of the neighbourhood, although he experienced little sensation, and did 
not pass any semen. At a later period, he addicted himself to the vice as 
often as two or three times a day. Still his health underwent no alteration. 
At the age of twenty-one, he entered a cavalry regiment, and soon after- 
wards had cholera, on recovering from which, he was sent to his native 
village for change. He hunted much at this time, and was constantly on 
horseback. About three months afterwards, he had sexual intercourse 
once or twice a-day, and on the fifth day he experienced very acute pain 
in the urethra during the passage of urine, but no discharge occurred. He 
resumed his habitual horse exercise, but abstained from the use of alcoholic 
drinks. x\bout two months later, B observed that he passed a con- 
siderable quantity of semen while at stool, even although his bowels were 
not constipated; and at the same time his calls to urinate became more 
frequent and more sudden, so that he passed water eight or ten times a-day, 
and four or five times in the night. Soon afterwards, after a long ride, he 
felt pain in the course of the left spermatic cord, which soon extended to 
the epididymis and testicle of the corresponding side. Orchitis was esta- 
blished, but yielded to the usual treatment, leaving, however, a chronic 
enlargement of the epididymis. Afterwards the patient wore a suspensory 
bandage, rode on horseback again, and again practised masturbation. He 
now, for the first time, experienced an extraordinary change in ejaculation. 
Very little semen was passed by the urethra, although he felt internally a 
sensation which announced abundant discharge. The greater part of the 
emission remained in the urethra, and was discharged after the subsidence 
of the erection ; even then the patient was obliged to assist its escape, by 
making pressure on the urethra. This occurred even during nocturnal 
pollutions. The diurnal discharges during defecation, and the frequent 
12 



178 CAUSES OF SPERMATORRHOEA. 

desire to micturate continued; the patient's health became again disordered, 
and when he returned to his regiment, he was just as weak and thin as when 
recovering from the effects of the cholera. 

After a few days' active service, swelling again attacked the left testicle : 
this was relieved by rest and emollients, but frequently returned again, after 
slight horse exercise. Acute inflammation also attacked the right spermatic 
cord, epididymis, and testicle. The inflammation was dispersed by leeches, 
but enlargement of the cord and epididymis remained. Some time after, the 
patient complained of pain in his chest, sense of suffocation, and frequent 
attacks of digestive disorder, and on the 6th of August, 1836, he was admitted 
into the hospital St. Eloi, under the care of professor Serre, in much the 
same condition that I have so frequently described. 

M. Serre cauterized the prostatic portion of the urethra, after which, the 
patient's efforts during defecation, together with the quantity of semen 
passed at stool, diminished. Micturition became less frequent, and his diges- 
tion and moral condition improved. In this state I saw him, a month after 
the cauterization : hoping that the amendment would continue to progress, I 
merely prescribed cold ascending douches every second day. Some time 
after, I found a slight difficulty in passing a catheter into the bladder. The 
instrument was caught near the neck of the bladder by a band, which caused 
a kind of starting upwards of its point. 

In any other part of the canal I should not have considered this obstacle 
worthy of notice, but its seat being near the orifice of the ejaculatory ducts, 
I questioned the patient further. From what I then learnt, I was induced 
to leave an instrument in the urethra for an hour, and to repeat this once 
a week. The ascending douches seemed to give tone to the rectum, and 
the introduction of the catheter freedom to the urethra. The seminal dis- 
charges diminished, and remarkable improvement in all the functions took 
place. On the 15th of October, however, a pollution occurred during defe- 
cation, and was repeated on the 19th. At the same time, the desire of 
micturition became more frequent. On the 21st of October, therefore, I 
determined on again performing cauterization of the prostate, applying the 
caustic especially to the membranous portion of the urethra in front of the 
orifice of the ejaculatory ducts. This second cauterization perfected the 
benefit begun by the first. Defecation was performed easily, and the pol- 
lutions accompanying it ceased, the urine became quite transparent, and was 
passed at normal intervals in a full stream, and without pain. A few abun- 
dant nocturnal emissions occurred at intervals of ten and fifteen days, but 
they were always preceded by erotic dreams, and accompanied with lively 
sensations, the seminal emissions taking place very freely and entirely. And 

on the 6th of December, B left the hospital, having been quite well for 

more than a month. I advised him, however, to exchange from a cavalry 
to an infantry regiment. 

Berthelot was of a very lymphatic temperament, and he had con- 
tracted habits of abuse four years before puberty. These circum- 
stances must have had their influence in determining the effects 
produced on the spermatic organs. But the immediate cause of the 
disease is very evident. Coitus was only repeated a few times, but 
whole days were passed on horseback. Riding exercise aggravated 
the disorder, and produced relapses. To its effects on the perineum, 



VENEREAL EXCESSES. 179 

the urethritis, and the repeated attacks of orchitis must be attri- 
buted. 

It was not by exposing the testicles to friction, as may at first sight 
be supposed, that the horse exercise induced orchitis ; the inflamma- 
tion commenced in the vas deferens, extended to the epididymis, and 
thence to the testicle. The action of the saddle on the perineum, 
therefore, increased the urethral inflammation, and favoured its ex- 
tension to the neighbouring mucous membrane. The irritation ex- 
tended, not only to the testicles, but towards the kidneys. The 
seminal vesicles were then in the same condition as the bladder, and 
presented the same phenomena — their situation between the ejacu- 
latory ducts and the testicles being the same as that of the bladder 
between the urethra and the kidneys. What passed in the bladder 
was only the exaggeration of what took place in the seminal vesicles. 
The influence of this phlogosis even extended to the sphincters of 
the anus, since the expulsion of relaxed motions required conside- 
rable efforts. 

I have already related (page 148) a case of nocturnal pollutions, 
in which no external evacuation took place, all the semen passing into 
the bladder, and being afterwards expelled with the urine. This 
occurred in consequence of compression having been made on the 
perineum to prevent ejaculation. I have seen another case, in which 
the same thing happened after blennorrhagia, and Berthelot presented 
something similar, but in him all the circumstances were still more 
marked. There could be no doubt as to the observations he made 
during masturbation. He always experienced the same voluptuous 
sensations, which were accompanied by a kind of internal perturba- 
tion, and he observed the discharge at the time of only two or three 
drops of semen. After nocturnal pollutions, he constantly found on 
waking, a considerable quantity of semen in the urethral canal. 
These phenomena were easily observed, and he did so many times. 

I have frequently seen the same effects take place in very long and 
tight strictures of the urethra; but in Berthelot, a No. 12 catheter 
passed easily into the bladder. The orifice of the ejaculatory ducts 
must, therefore, have been altered by some cicatrix in the neighbour- 
hood of the verumontanum. The presence of this was made evident 
by the slight deviation of the point of the catheter before entering 
the bladder. The presence of such a cicatrix, in this situation, in- 
dicates clearly enough that inflammation has been active near the 
orifice of the ejaculatory ducts: hence it may be supposed, that the 
effects of horse exercise on the perineum must have contributed to 
its development, and to the extension of the inflammation so fre- 
quently to the testicles. 

I have shown in another place (page 100,) that horse exercise may 
contribute to produce diurnal pollutions by its action on the margin 
of the anus causing obstinate constipation ; and I have also pointed 
out that it may have very injurious effects about the period of puberty 
(page 151,) by inducing accidental emissions, or leading to bad habits. 
These cases, with those I have just related, show that horse exercise 



180 CAUSES OF SPERMATORRHOEA. 

may cause hurtful excitement of the genital organs : first, by inducing 
obstinate constipation; secondly, by producing abnormal excitement, 
which may lead to abuse; thirdly, by rendering coitus irritating; 
fourthly, by increasing irritation previously set up by recent excesses. 

I do not pretend to assert that horse exercise often produces such 
unfortunate results, but it is important to know how and under what 
circumstances they may be produced — in a word, what influence 
horse exercise may have in causing spermatorrhoea. All that I have 
now said of course applies to the other exercises which act on the 
genital organs, and whose action, though less energetic, may be more 
prolonged. 

Every one knows the effect produced by long journeys, even in the 
easiest carriages. The increase of temperature which all the parts 
that bear the weight of the body experience, and the continual shaking 
to which they are submitted, excite importunate erections, which are 
commonly followed by fatigue and irritation. The increased flow 
of blood often suffices to reproduce urethral discharges which had 
ceased for some time. I have been consulted many times in cases 
of this nature — indeed, there are some persons who cannot pass a 
few days in travelling, without having a slight gleet. These effects 
are not equally severe in all, but all experience an increased excite- 
ment, which it is necessary to be guarded against, because it excites 
desires which may be easily mistaken for real necessities. There is 
more importance in these apparently trivial circumstances, than is 
generally supposed. Hence I have called attention to them en 
passant, 

I have already shown, that the action of alcoholic liquors on the 
genital organs may induce spermatorrhoea, (see case twenty-one.) 
I now proceed to show the influence they exert on the venereal act. 



CASE XLIV. 

Lymphatico-sanguineous temperament — Coitus when nearly intoxicated at 
the age of twenty-two — Blennorrhagia — Pollutions during defecation — 
Disturbance during ejaculation — Band in the membranous portion of the 
urethra — Cauterization — Cure. 

Gros, a soldier in the 57th regiment, set. twenty-five, of lymphatico- san- 
guineous temperament, always enjoyed perfect health, until, in 1833, after a 
debauch he had sexual intercourse. He only remembers that the coitus was 
very long and slightly painful. Immediately afterwards, he felt pain in the 
pelvis, which soon extended to the testicles, and never entirely left him 
afterwards. The following day a clear urethral discharge came on, which 
soon, however, became greenish. This varied much in its after appearances, 
and sometimes passed off entirely for a day or two. This blennorrhagia drew 
the patient's attention to a discharge from the urethra during defecation. 
At first, a few drops of a viscid fluid like white of egg were discharged, and 
these were followed by an abundant evacuation of semen. This evacuation 
always took place, varying in quantity according to the efforts required during 
defecation. 



VENEREAL EXCESSES. 181 

From this time the patient practised masturbation, and at the moment of 
ejaculation, he felt a kind of commotion in the urethra, and observed that 
nothing was passed externally. After the erection had subsided, the semen 
escaped gradually. This he always noticed, though sometimes the semen 
remained in the canal for half an hour. When nocturnal pollutions occurred, 
the greater part of the emission remained in the urethra until the patient 
awoke. 

During eighteen months, Gros underwent no medical treatment; after- 
wards he took emollients, preparations of iron, mercurial pills, large doses 
of copaiba and cubebs, and of Chopart's mixture; injections of all kinds 
were also employed without benefit. About the end of August, 1836, he 
came to consult me. He had frequently had sexual intercourse without 
communicating any disease to the female. The urethral discharge, and 
the pollutions during defecation, continued to the same degree ; the urine 
was passed very frequently, and was generally rendered opaque by a thick 
cloud. Still, however, the patient's functions were performed pretty regu- 
larly, and he had not lost flesh; but his muscles were soft and flabby, his 
thoughts gloomy, and his voice weak and husky. Constant pain had an- 
noyed him for two years in the joints, groins, and along the spermatic cords 
to the testicles. His eyes were intolerant of light, and constantly affected 
by a prickling pain. 

The introduction of a catheter gave acute pain; the instrument was arrested 
for a moment in front of the neck of the bladder, by a little band, which 
tilted up its points. 

On the 7th of October, I cauterized the membranous portion of the canal; 
acute and long continued pain followed, and the urine was bloody and abun- 
dant. This inflammation had entirely disappeared at the expiration of three 
weeks, when the discharge rapidly diminished and soon disappeared. The 
efforts at stool, and the seminal discharges which accompanied them, had 
ceased much earlier, and the pains in the groins, spermatic cords, and tes- 
ticles, as well as the sensations the patient experienced in his eyes were 
relieved. 

When Gros left the hospital, he was free from all the appreciable symp- 
toms which he had on entering; as regarded ejaculation, of course he was 
unable to give any information, but he promised to let me know if he found 
the discharge arrested in the canal as before, and from that time I have heard 
nothing from him. 

This patient was in the hospital at the same time as the subject 
of the preceding case, and I placed them in adjoining beds, in order 
the better to contrast their symptoms. Both were of the same age, 
and both' experienced the same pollutions, and the same difficulty of 
ejaculation after an attack of non-contagious urethritis. The point 
of the catheter communicated the same sensation of obstruction m 
both, and the same treatment cured them both. 

^ I need not at present recur to what I have stated respecting a 
cicatrix situated in front of the orifice of the ejaculatory ducts. The 
most simple and direct means by which to obviate its effects is an 
active cauterization in front of the verumontanum. On this account, 
in these two patients, I more particularly cauterized the membranous 
portion of the urethra. 



182 causes or spermatorrhoea. 

In the case of Gros, a single connexion gave rise to all the acci- 
dents; therefore, it can scarcely be said that he committed excesses; 
but the act was not brought about by a natural necessity; it was 
accomplished in a laborious manner; under circumstances very likely 
to prolong its duration, and whilst the mucous membrane of the 
genito-urinary organs was exposed to considerable over excitement. 
The act was therefore inopportune, and as such, it produced the 
effects of an excess. The urethritis following it seems to have been 
produced by the excessive duration of the act, and by the excitement 
of the organs by alcoholic stimuli before they were submitted to 
this fatigue. The colour of the discharge showed that it was not 
spermatic. It seemed to be an ordinary gleet, arising from the same 
cause as the chronic vesical catarrh and the involuntary seminal dis- 
charges. 

CASE XLV. 

Coitus in a state approaching inebriety — Gleet increased by a journey — 
Diurnal pollutions — Cauterization, with rapid improvement — Relapse 
from premature fatigue of the organs — Cure by means of antiphlogistics 
and rest. 

M. R , a student of medicine, a native of the tropics, and of a very 

nervous temperament, addicted himself to masturbation about the period of 
puberty, and to later, venereal excesses, and the use of alcoholic liquors. 
His health became disordered, but by a regular life and exercise he strength- 
ened his constitution, and for several years his health was excellent. 

In 1836, after a debauch, when nearly intoxicated, he repeated coitus 
twice during the night, each time with unusual difficulty. On the fourth 
day he experienced pain in the canal, and scalding during the passage of 
urine. A slight mucous discharge soon appeared, and became more abun- 
dant by degrees. Baths and emollients diminished the irritation; but it in- 
creased afresh during a long journey, which the patient was obliged to take. 
After his return, he often applied leeches, and took copaiba, without being 
able to lessen the discharge. Every morning and evening and during the 
day, the point of the glans was moistened by a drop of viscid fluid. This 
circumstance would not have attracted his attention if he had not at the same- 
time noticed a remarkable diminution in his virile powers. Ejaculation be- 
came very rapid; the erections remained incomplete; and several times the 
act was impossible. The patient had pain in the spermatic cords and testicles; 
a sense of weight in the perineum, and at the margin of the anus; both his 
limbs and his intellect grew weak. Absorbed, in spite of himself, in con- 
sideration of his condition, he was unable to pay atttention to any thing else. 
He lost his memory, was constantly abstracted, and incapable of applying 
himself in any intellectual employment, or bodily exercise. This mental and 
physical weakness, together with the disorder of all his functions, had increased 
rapidly, when the patient came under my care. It was not difficult to dis- 
cover the origin of his disorder. Each stool was accompanied by more or less 
abundant seminal discharges, and the patient's urine constantly contained a 
considerable quantity of well formed semen, full of granules like boiled rice. 



VENEKEAL EXCESSES. 183 

In the beginning of June, 1837, I cauterized the prostatic portion of the 
urethra, The operation produced its ordinary immediate effects. As soon 
as the inflammation had passed off, the diurnal pollutions disappeared, and 
energetic erections returned. The premature use of coitus, however, added 
to over fatigue during very hot weather, reproduced the irritation in the 
urethra, together with the diurnal pollutions, and the general symptoms that 
accompanied them. This relapse I treated with leeches, baths, enemata, 
and strict repose, which simple means soon brought about a perfect cure, and 
rendered a second cauterization unnecessary, although the patient pressingly 
demanded it. 

Under other circumstances M. R had committed considerable 

excesses without experiencing any ill effects. To what, then, can 
we attribute the occurrence of the urethritis and the diurnal pollu- 
tions following it, but to the effects of the alcoholic stimuli ? 

The last part of this case shows how necessary it is not to disturb 
the effects of cauterization by any circumstances which may re-excite 
the irritation. It would be dangerous to recur to the same treat- 
ment, when irritation is again set up a few days after cauterization 
by the influence of exciting causes. When on the other hand, under 
such circumstances, antiphlogistics are employed, and rest is enjoined, 
the symptoms disappear rapidly ; the cure is, therefore, only retarded : 
a second cauterization in such a case might be expected to produce 
much disorder. 

These effects from the excessive use of stimuli are by no means 
rare, judging from the number of cases I have met with ; the two 
related are, however, sufficient to give an idea of the general circum- 
stances attending such cases; I shall, therefore, only extract the 
most important features of the others of which I have notes. 

None of my patients were completely intoxicated at the moment 
of coitus, but all were more or less approaching that state. Few 
repeated the act ; and some even were unable to terminate it. In 
all it was long, laborious, and attended with little pleasure; and 
the inflammation or irritation of the urethra came on very quickly. 
Urethral discharge did not invariably arise; when it did occur, it 
appeared very quickly. The pain produced, as well as the colour of 
the discharge, differed much in different individuals. In two cases 
retention of urine occurred on the day following, and in another, 
prostatitis was set up. Several patients passed dark-coloured and 
even sanguinolent urine for several days. 

All fermented drinks are not equally hurtful, and according to my 
experience, beer produces the worst effects, especially when new. 

To resume: — a state approaching intoxication may be hurtful in 
two ways ; first, by diminishing the sensibility of the nervous system ; 
secondly, by favouring the occurrence of irritation in the genito-uri- 
nary mucous membrane. As this double action may appear contra- 
dictory, I will explain it. 

During complete intoxication coitus is impossible, because the 
functions of the cerebro-spinal system are suspended. But when 



184 CAUSES OF SPERMATORRHOEA. 

fermented liquors have produced effects short of stupefaction, when 
excitement is followed by a commencing weakness, with a disposition 
to somnolency, venereal excitement is frequently manifested, on the 
nature of which it is very easy to be deceived, because in this state 
nothing is feared. 

Indifferent erections occur. These may suffice to permit the com- 
mencement of coitus, but the sensibility of the genital organs is 
blunted, for the same reason that all other sensations are vague and 
dull. The pleasurable feeling may be sufficient to keep up the erec- 
tion, but does not suffice to produce that high state of excitement 
which is necessary for the accomplishment of the act. This diminu- 
tion of sensibility then, renders coitus incomplete, or retards its con- 
summation, sometimes even rendering it impossible. It becomes 
evident, therefore, that such ineffectual efforts must favour the de- 
velopment of irritation in parts which are at the same time in a state 
of more or less active congestion. 

Again, on the other hand, it is well known that fermented liquors 
irritate the genito-urinary organs, and that those who take them in 
excess frequently lose their virility. It is well known too, that 
drunkards are subject to chronic catarrh of the bladder, to engorge- 
ment of the prostate, dysuria, retention of urine, and chronic gleet ; 
and I have before shown that wine is hurtful to patients labouring 
under spermatorrhoea, (see case 21.) 

Fermented drinks, then, taken in excess, produce an excitement in 
the genito-urinary organs, which is very likely to run into a state of 
permanent irritation, at the same time that they disturb the intellect, 
blunt all sensations, and prolong the efforts of coitus by postponing 
the convulsive action which concludes the act. Hence it occurs that 
these tissues, already irritated by the direct action of the fermented 
liquors, are still more disordered by the violent and prolonged action 
of such unsuitable efforts. It is not wonderful, then, that coitus 
under such unfavourable circumstances should often produce hurtful 
results. 

Characteristics of venereal excesses. — The immoderate and conse- 
quently injurious use of a thing, useful within proper limits, consti- 
tutes an excess. We must, therefore, consider the act of sexual in- 
tercourse under two points of view, in order fully to understand its 
different effects. It is widely different from all abuses, which can 
never be of service, however rarely they may be practised. 

But to what extent may intercourse be regarded as moderate and 
useful, or at all events as not hurtful ? When do excesses and con- 
sequently danger commence ? These important questions have never 
been clearly resolved. In such a consideration each consults his own 
experience, and arrives at a different conclusion. The power and 
activity of the organs of generation, as I have already stated, vary 
extremely in different individuals, and even in the same individual at 
slightly distant periods. No other organs in the economy present 
so great a variety in the activity of their functions. It is, therefore, 



VENEREAL EXCESSES. 185 

evident that any statement in numbers would be incorrect as regards 
the majority of cases. 

The ivants of the genital system can alone furnish data applicable 
to each case. But the appreciation of these wants is not so easy as 
might be supposed. They vary with the individual, with the age, 
and a host of other circumstances, th« combinations of which are al- 
most infinite. 

The genital ivants may be factitious ; a violent attachment may, in 
this respect, give rise to great illusions ; the direct irritation brought 
on by Herpes preputialis, or by the presence of ascarides in the rec- 
tum, may excite morbid erections which have no connexion with the 
real wants of the system. Irritation of the cerebellum, the spinal cord, 
or the nerves supplying the genital organs, may produce the same 
effects, so that the frequency and duration of the erections will not 
always show the amount of the true powers. In many persons the 
desires are greater than the powers of fulfilment; the imagination of 
such is constantly occupied by erotic ideas whilst their physical pow- 
ers are very little. The impulse in these persons is purely derived 
from the brain, and their immoderate desires cannot, therefore, fur- 
nish a measure of their real wants. 

On the other hand, a too absolute and lengthened continence may 
end by throwing the genital instinct into a state of inertia, which 
might be mistaken for impotence, and which may lead to it, as we 
shall see -by and by. 

Excessive spermatic plethora is generally accompanied by a feel- 
ing of uneasiness and anxiety, with general discomfort, headache,lazi- 
ness, and somnolency, or perhaps, in other cases, agitation, sleep- 
lessness, impatience in temper, inaptitude for intellectual employ- 
ment, despondency, love of solitude, and swelling and pain of the 
spermatic cords and testicles. These symptoms are especially seen 
about the age of puberty, in lads who have escaped falling into bad 
habits, and who have never had sexual intercourse ; they are not rare 
in persons more advanced in life, who have been suddenly deprived 
of intercourse which had become habitual to them. It is remarkable 
that many of the same symptoms are found in cases of spermatorrhoea. 
It is sufficiently astonishing to find such opposite causes producing 
similar results, yet we see the same thing occur daily in other cases. 
For instance, too large or too often repeated bleeding constantly pro- 
duces vertigo, dizziness, noise in the ears, convulsions, palpitation of 
the heart, &c, although these symptoms usually depend on a state of 
plethora. I have related many cases in which extreme weakness was 
accompanied by symptoms likely enough to cause a dread of apo- 
plexy, cerebral affections, or disease of the heart. 

From such facts, then, we may conclude, that opposite conditions 
of the economy may produce phenomena sufficiently alike for skilful 
practitioners to be mistaken in them ; and we must not be astonished 
at finding that a too long continence should bring on phenomena 
similar to those observed after too often repeated seminal discharges. 



186 CAUSES OF SPERMATORRHOEA. 






It is difficult, then, to judge a priori of the real wants of any indi- 
vidual, because the frequency and duration of the erections, the 
activity of the venereal desires, and the phenomena observed in the 
different functions of the economy, may prove deceitful. This is not 
the case, if we only consider the effects that immediately follow the 
venereal act. It is then always easy to foresee the remote conse- 
quences which are to be expected from more frequent sexual indul- 
gence. The following signs cannot be misunderstood, and are ap- 
plicable in all cases. 

When coitus is followed by a sense of happiness, of general com- 
fort, and of increased strength ; when the intellect is more acute, and 
the body more active ; when an inclination to take exercise, or to 
engage in intellectual excitement is observed, together with increased 
activity of the genital organs, it is evident that an imperious want has 
been satisfied within the limits necessary to health. The happy in- 
fluence all the organs experience from the act is similar to that which 
follows the accomplishment of every other function necessary to the 
economy. 

When, on the contrary, coitus is followed by a feeling of sadness, 
of uneasiness, fatigue, or satiety; when heaviness of the head and a 
disposition to sleep occur, with confusion in the ideas and disinclina- 
tion for exercise, it may be presumed, that the act has been too often 
repeated, or performed under unfavourable circumstances; and erec- 
tions, however energetic, which occur soon afterwards, should be 
considered as excited by the commencement of irritation, and not by 
the return of the want. 

It is only when coitus is followed by all these marks of debility, 
that it is injurious; indeed, sadness, ill temper, and regret are never 
shown, unless the act be too often or unseasonably repeated. Such 
conditions, therefore, should be sufficient to show that there has been 
either excess or unfitness — which produce the same effects. 

These two classes of phenomena, however, are rarely of so striking 
a nature as I have just supposed, because on the one hand, the want 
is seldom very imperious, and on the other, the excess is seldom very 
great; but at the same time there are few who have not experienced 
something analogous to the one case or the other. Cases intermediate 
between these extremes, constitute the ordinary course of life; then 
coitus is followed by no remarkable phenomena, and hence we must 
conclude that in the majority of cases it is far from exerting the 
hurtful influence on the economy that has been attributed to it. It is 
true, that I have related cases in which coitus seldom repeated was 
attended by the most unfortunate results ; but in such cases the pre- 
vious or concomitant circumstances must be taken into consideration. 

The causes capable of rendering coitus hurtful are very various 
and frequent. I have hitherto only considered a few of them. I 
now proceed to comment on others, which may act indirectly in 
bringing on spermatorrhoea, either by inducing excesses or by dis- 
ordering the act itself. 



VENEREAL EXCESSES. 187 

Causes of Venereal Excesses. — In a former chapter I have 
pointed out the pathological causes that may bring on accidental 
irritation of the genital organs and excite abuse : it is evident that 
the same circumstances may equally lead to venereal excesses: what 
I have already said, therefore, applies to the subject specially under 
our consideration. 

Age. — The sensibility which the genital organs acquire at the age 
of puberty, the kind of habitual orgasm of which they become the 
seat, the confidence in strength imparted by an unusual sense of vi- 
gour, together with the want of experience, may cause the youth to 
be carried away by the violence of his first feelings. But generally 
from our social state, he experiences obstacles sufficiently powerful 
to subdue his passions more or less completely. This would be 
highly advantageous, if the desires did not break forth at a later pe- 
riod, in a manner even still more dangerous. It is rarely, then, that 
the youth meets with circumstances favourable to habitual excesses 
capable of injuring his health. I have met with few such examples 
at this early age, in comparison with the number of cases of mas- 
turbation. 

When, however, the development of the man is completed, and the 
law sanctions his emancipation from authority, he enjoys perfect 
freedom in his actions, or he marries ; and then it is, that free from 
all restraint, he gives license to his previously subdued passions. 
But if sexual intercourse is more frequent now than at any other 
period, the virile power also exists in greater energy, and the resist- 
ance to the causes of injury is more active: if the excitement, there- 
fore, arise only from the genital organs, there will be no greater ex- 
cesses now than at any other time, because the real wants are 
greater. 

At a later period the powers diminish by degrees, until they be- 
come extinguished in old age, but the desires follow the same course. 
Thus then the energy of the genital organs, at the period of the 
greatest virility, would not suffice to induce excesses, if other causes 
were not superadded ; and, on the other hand, the diminution of their 
power, with advancing age, would not render coitus more dangerous, 
but more rare. 

Temperament. — The predominance of the lymphatic temperament 
renders the economy little capable of supporting venereal excesses, 
but at the same time, this temperament predisposes to them less than 
any other. All other circumstances being equal, individuals, in 
whom the lymphatic temperament is very marked, are less excitable 
and less susceptible of being carried away by their passions. 

The sanguineous temperament seems to be the one most favourable 
to activity of the genital organs ; but at the same time this tempera- 
ment supports such activity better than any other. 

"In persons of nervous temperament the action of the genital organs 
is apt to be confounded with that of the brain ; of which I shall speak 
shortly. 



188 CAUSES OF SPERMATORRHEA. 

Neither age nor temperament, then, can be set down as the true 
cause of venereal excesses, and of the disorders to which they give 
rise. 

Genital Instinct— The organs composing the reproductive system 
may be divided into two very distinct systems, the one destined for 
the material performance, the other for manifesting the impulses and 
directing the actions which lead to it. Proper harmony generally 
exists between these two systems at the periods of evolution and 
diminution of power in the organs, as well as at the time of their 
greatest power and activity: this is why the phenomena having refe- 
rence to generation have been generally attributed to the exclusive 
influence of the sexual organs, such influence being more easily 
observed than that of the encephalon. I have, however, shown that 
the genital instinct may be developed long before the epoch of 
puberty ; I now proceed to show that the two systems have not inva- 
riably an equal degree of development or activity, and to point out 
the results of the preponderance of one system or the other. 

Genital Organs. — No other organs present such considerable diffe- 
rences either in development or power. I have met with individuals 
who early addicted themselves to unbridled masturbation, and who 
afterwards committed great venereal excesses, continued even to the 
age of sixty, without notable injury to their health; whilst on the 
other hand, I have seen others, who experienced very serious noc- 
turnal and diurnal pollutions, as a consequence of very slight errors 
of conduct. 

These differences of constitution are not always marked by charac- 
ters announcing a predominance of one of the elements which con- 
stitute the organs ; still less are they shown by the development of 
the frame or the muscular system. Thus, with a sanguineous, a ner- 
vous, or a lymphatic temperament, and with either a robust or a de- 
licate constitution, the genital organs may present all the varieties 
of size, power, or activity. 

The condition which predisposes least to sexual excesses is that 
in which development of the genital organs predominates over that 
of their encephalic organ. I have met with young men of extraor- 
dinary virile powers, who were only impelled by their physical wants. 
They experienced frequent and importunate erections, but their ima- 
gination remained unexcited. They practised masturbation, or had 
recourse to sexual intercourse, to free themselves from uneasiness, 
and thought no more of the act as soon as this uneasiness had ceased. 
Such patients have always consulted me for syphilis or blennorrhagia. 
The opposite conditions are those which predispose to excess. 

Encephalic Organs. — I do not pretend to give an opinion here on 
the part of the brain which receives the sensations derived from the 
sexual system. It is enough to know that some such organ exists, 
and that its action may precede that of the genital organs, and con- 
tinue after it, or in other words, that this action of the brain may pre- 
dominate. Such predominance of the genital instinct over the mate- 



VENEREAL EXCESSES. 189 

rial instruments, is in general shown very early. The children we 
see occupied with women, five, six, or even ten years, before puberty, 
almost always show, during the rest of their lives, the same suscepti- 
bility for all that may produce or recall erotic ideas, whether such 
impressions arise from the genital organs, or are excited by the senses. 
They preserve a very lively and enduring remembrance of these im- 
pressions ; their imagination gloats over them, and considers them in 
a hundred different ways : voluptuous images are mingled with their 
most serious thoughts, disturb all their meditations, and are present 
even in their dreams. They covet all women ; but their virile powers 
do not suffice for the activity of their desires. Coitus fatigues and 
enervates them ; they are aware of this, but are drawn into excess in 
spite of themselves, and as often as they are physically able. Such 
persons have no more power over their will than the insane ; when 
they feel worn out after coitus, they make the best resolutions, which 
they break as soon as they are able, at the same time foreseeing that 
they will experience injurious effects from such infringement. 

When desires are only excited by spermatic plethora, they are 
appeased as soon as the want is satisfied, and only return when the 
loss is repaired. There could, therefore, never be a real excess in 
such a case, if other causes did not determine the more frequent repe- 
tition of the act. Grave excesses, however, are almost inevitable, 
when the desires are found in great disproportion to the real wants of 
the system. A brilliant and active imagination, an exquisite sensi- 
bility, and great brilliancy of ideas are often joined to this predomi- 
nance of the sexual instinct. Individuals imbued with the spirit of 
poetry, whom we call nervous, frequently attach the most seductive 
colours to their recollections, and embellish them with imaginary 
charms ; but their devouring passions are badly supported by their 
weak and irritable organs. 

Such predominance of the nervous system too, renders the organs 
exposed to abuse or excess more impressionable; and as their func- 
tions may be easily perverted, it is evident that such individuals are 
very liable to the occurrence of spermatorrhoea. Other impulses 
derived from the faculties of the mind, may also induce an individual 
to overstep the limits of his true necessities. Of these I shall now 
speak. 

Vanity is perhaps the most common cause of venereal excesses. 
Man covets the esteem of his race ; and especially that of woman, 
of whom he is the natural protector. It is when in the presence of 
woman that he is proud of his intellectual and physical superiority, 
and of his social position; but it is his virile power of which he is 
especially proud, and which he endeavours to prove — those who are 
the least strong in this respect, fear the most to allow their weakness 
to appear. Hence excesses arise, which are not caused by the real 
necessities, and which do not spring from a violent passion. Young 
men who have given themselves up to the ardour of their passions 
soon after their marriage, endeavour to sustain the excesses with 



190 CAUSES OP SPERMATORRHEA. 

which they commenced. They dread causing a suspicion of cool- 
ness, or of infidelity, though they very soon repent their first impru- 
dence — their irritated organs being no longer in the physiological 
condition which at first permitted them to support excesses. If I 
may judge from the facts I have learned from patients, their venereal 
excesses have been caused more frequently by an unfortunate vanity 
than by an ardent attachment. I admit all that an exclusive and 
blind passion concentrated on one object is capable of; but this does 
not prevent the impulses of which I have just spoken from acting at 
the same time; it must even lend them more energy. 

Excitement caused by an ardent attachment undoubtedly exposes 
to great excesses, and it is not less evident that these excesses may 
become hurtful; but they are not so much so as if, were it possible, 
the same individual had committed them with perfect indifference. 
This is easily explained by referring to the excitement which the 
whole economy receives from feelings of joy and pride. 

The sensations are more lively in proportion as the semen is better 
formed, and has remained (within certain limits) longer in its reser- 
voirs. The excitement caused by its long continued presence, may 
even proceed so far as to bring on a state of erotic fury almost resem- 
bling mania. On the other hand, the sensations lose their acuteness 
when the semen begins to lose its stimulating properties, and coitus 
becomes more and more insensible, in proportion as the semen be- 
comes more watery. All those who have, consulted me in conse- 
quence of spermatorrhoea following venereal excesses, had remarked 
this diminution of pleasure long before any change took place in their 
health. At the same time that the sensations diminish, the erections 
become less perfect, and of shorter duration; they may even become 
so precipitate, that intromission is impossible. However rarely prac- 
tised, coitus now is always followed by serious and general disorder, 
which passes off very slowly, sometimes even continuing ten days or 
a fortnight. 

The diminution of pleasure is, therefore, the first sign which indi- 
cates that the individual has exceeded the limits of his real wants. 
The danger increases with the imperfection of the act. 

What I have just stated is applicable to all seminal discharges, in 
whatever manner they may be produced ; but by comparison, it be- 
comes clear, that they are more dangerous in proportion as they take 
place with less energy and afford less pleasure. 

I need not repeat what I have already stated respecting the effects 
of coitus, as compared with those of masturbation ; most surgeons 
agree on this point ; but the same differences exist with regard to 
involuntary discharges. The same individual who could repeat coitus 
several times without inconvenience, often feels worn out after a sin- 
gle nocturnal pollution. Advantage is always found to arise from 
substituting the natural mode of discharge for nocturnal pollutions, 
when those do not arise from irritation. The normal excitement 
resulting from coitus in such cases, gives tone to the whole economy, 



VENEREAL EXCESSES. 191 

and especially to the genital organs ; the discharges that take place 
are more easily compensated, and contraction of the ejaculatory 
ducts more actively opposes involuntary discharges. ^Nocturnal 
pollutions, on the contrary, leave the tissues in a state of atony, 
increase the relaxation of the ejaculatory ducts, and expose the 
patient to a return of the same accidents, and afterwards, to diurnal 
pollutions. When nocturnal pollutions arise from irritation of the 
genital organs, coitus, by increasing that irritation, proves injurious; 
but when they are due to habit or to relaxation of the parts, coitus, 
even when often repeated, is of service as a substitute for them. 

Nocturnal pollutions, when compared together, are liable to the 
same observations. All the patients who have consulted me in such 
cases, have noticed that at first the emissions were accompanied with 
dreams, violent erections, and lively sensations, and that they were 
then borne without injury; but that in proportion as these pheno- 
mena of excitement diminished, the pollutions produced more serious 
and lasting effects. Those which took place without erection or 
sensation were the most depressing. Diurnal pollutions, too, caeteris 
paribus, are more serious and more difficult of cure than nocturnal 
ones ; and those which accompany the discharge of urine are more 
distressing than such as take place during efforts at stool. In a 
word, experience has convinced me that involuntary seminal dis- 
charges are serious in proportion as they occur easily. 

To sum up then : whether the excitement arise from the cerebral 
system, the passions, &c, or from the presence of well formed semen, 
emissions accompanied' with the most energetic phenomena can alone 
be useful or uninjurious ; and, caeteris paribus, seminal discharges are 
more hurtful in proportion as they are accompanied by less ener- 
getic erections, and less lively sensations : in a word, as they are 
more passive. 

I consider it of some importance thoroughly to establish this as 
a general principle, both because it is opposed to the ideas usually 
entertained on the subject, and because it is of daily application to 
the study and treatment of both voluntary and involuntary seminal 
discharges. 

Accidental influences. — I have already spoken of the immediate 
effects of horse exercise, and alcoholic stimulants, as well as the 
remote ones of masturbation, and blennorrhagia. One or two phe- 
nomena arising during sleep, deserve mention. 

Accumulation of urine in the bladder during the night, is a power- 
ful cause of excitement of the genital organs — another proof of the 
intimate connexion between the genital and urinary systems. This 
influence is well known to all who suffer from nocturnal pollutions; 
nearly all such, warned by their own observations, take care to empty 
the bladder before going to bed, and every time they wake. Some 
even get into the habit of waking at stated periods for this purpose, 
and abstain from taking fluids in the evening. Others have told me 
that the presence of feces in the rectum produces the same effects. 



192 CAUSES OF SPERMATORRHEA. 

The heat of the bed is also a powerful stimulus to the genital organs. 
It is not, therefore, surprising that the morning should be the period 
most to be feared by those addicted to masturbation, or tormented 
by nocturnal pollutions. Such erections, in most cases, do not arise 
from real wants, and therefore coitus becomes injurious. The act 
is indeed more or less an excess according to the weakness of the 
individual, and must be avoided. 

General Effects of Venereal Excesses. — From the most re- 
mote ages a striking contrast has existed between the inhabitants of 
the east and those of the west. The following characters mark the 
different types. On the one hand, their habitual idleness and inac- 
tivity ; dread of physical disturbance, or moral agitation ; of change 
of any kind ; and of all employment either of the body or mind ; a 
dreamy existence ; the life passed apart from men, and shut up 
among women; while on the other hand, their restless and constant 
activity; love of independence and liberty; an active life; aptitude 
for business; love of glory and aggrandizement; boldness and per- 
severance in enterprise ; devotion to country and to principles ; ardent 
desire of improvement, and of conquest, both by prudence and in- 
dustry, and by war and colonization, by the patient observation of 
facts, and by the constant searching after truth. These characters 
have continued among all the changes of religion and politics, and 
are even more marked than ever at the present day. Considering 
all circumstances, the differences appear to me to arise almost en- 
tirely from the difference between the eastern and western nations 
in respect to marriage. On the one hand, there is polygamy, and 
on the other, monogamy. Throughout the east polygamy is encou- 
raged ; hence we see cowardly despots with crowded harems among 
the rich, and an impoverished and debased population, with a scarcity 
of females among the poor ; from the latter circumstance the most 
revolting vices arise. In the west, on the contrary, monogamy is a 
strictly preserved institution ; and we have domestic felicity, moderate 
governments, energetic and active lives; science flourishes; and the 
western nations have gradually become the mistresses of the world. 

A circumstance remarked by many travellers in the east is, the 
anxiety with which cantharides and all other aphrodisiacs are sought 
after. Impotence arising from venereal excesses is common at an 
early age. The generative functions, then, appear to possess a very 
powerful and direct influence on the state of society, by affecting the 
physical and moral strength of those who compose it. 

Special Effects of Venereal Excesses.— The influence of venereal 
excesses in producing involuntary seminal discharges was perfectly 
well known to Hippocrates : it is probable however, that he was aware 
of other causes. 

How do venereal excesses act in inducing spermatorrhoea ? By 
the influence of habit? by causing atony and relaxation of the parts ? 
Doubtless we must take these circumstances into consideration ; but 
there is a much more serious and much more frequent one. The 



VENEREAL EXCESSES. 193 

local phenomena that immediately follow coitus, may be modified by 
the circumstances which preceded or accompanied the act; but they 
always present more or less increased action in the genital organs ; 
the effects that result may then be referred to excitement, to irri- 
tation, or even to inflammation. 

Whilst the organs are healthy, and intercourse is proportioned to 
the wants of the system, its effect is simply tonic and stimulant. 
The semen is more abundantly secreted and more energetically re- 
tained in the seminal vesicles, and so far the influence is useful, 
being within proper bounds. Coitus therefore is, under favourable 
circumstances, the natural excitement of the genital organs. 

This is not the case with regard to masturbation, and the other 
abuses of which I have spoken, and hence such habits are so perni- 
cious. Disturbance, disorder, and irritation alone result from unna- 
tural abuses ; a tonic effect is never produced. Intercourse, there- 
fore, is substituted with advantage for either voluntary or involuntary 
discharges, so long as there is no irritation in the organs, but when 
irritation has once been set up, intercourse always increases the 
nocturnal and diurnal pollutions. A single connexion, if there be 
irritation of the organs, may produce the most unfavourable results. 
Excesses, therefore, when the organs are healthy, do not produce 
their effects at first. But when they have been continued for some 
little time symptoms of irritation supervene, ejaculation takes place 
very rapidly, and there is often heat felt during micturition ; the 
urine is more abundant, and there is frequent desire to pass it; the 
orifice of the urethra is red and injected. This irritation extends 
to the prostate and margin of the anus, as shown by a feeling of 
weight and uneasiness in the rectum and perineum, and by contrac- 
tion of the sphincter ani, producing constipation. The spermatic 
cords and testicles are painful on pressure, and require to be sup- 
ported by a bandage. 

Sometimes chronic or even acute inflammation of the urethra may 
arise. In 1831, I was consulted by a peasant, about thirty years of 
age, for urinary fistula in front of the scrotum. He married at the 
age of twenty-two, and never had intercourse except with his wife, 
who, on the other hand, never suffered from leucorrhoea, or vaginal 
discharge. The patient committed such excesses, that soon after 
his marriage inflammation of the urethra came on ; this was situated 
chiefly in the spongy tissue, for there was very little discharge, and 
the chordee very severe. The passage of urine became difficult, and 
an abscess formed and broke in front of the scrotum. From care- ' 
ful and repeated examinations I am convinced that the urethra was 
completely obliterated to the extent of five or six lines, about half 
an inch in front of this fistula. The inflammation in this case then 
must have been severe, and it would appear that it was produced 
solely by excessive coitus. 

The inflammation of the prostate is not always confined to its mu- 
cous follicles, it extends sometimes to the cellular tissue uniting them. 
13 



194 CAUSES OF SPERMATORRHEA. 

Hence results more or less severe and complete retention of urine. 
In such cases catheterism should be avoided if possible. 

Venereal excesses may also produce acute or chronic cystitis. I 
have lately treated a severe case of chronic cystitis, which had lasted 
five years, and came on soon after a second marriage at the age of 
forty-five. 

I have also several times met with symptoms of nephritis in indi- 
viduals who had committed great excesses, and in whom no other 
appreciable cause seemed to have acted. 

Inflammation of the vasa deferentia and testicles is by no means 
rare as a sequel to venereal excesses. The manner in which such 
inflammation is produced is well known. 

Serious effects are, however, by far the most rare. I have not 
laid stress on them in order to show what ordinarily occurs, but that 
which takes place when the symptoms are less severe may be under- 
stood. Since irritation from venereal excesses passes so readily to 
the prostate and bladder, the seminal vesicles cannot escape, and 
this explains why involuntary emissions supervene. It is evident 
also from this fact that the involuntary discharges do not arise from 
atony or relaxation. 

It is, however, difficult exactly to determine where the excitement 
of the genital organs that follows coitus begins to pass into irritation. 
As it is of much importance to decide this point, I shall describe the 
most usual symptoms that are manifested during the change. 

At first the erections are more frequent and more energetic, and 
lead to a belief in a vigour which does not exist. New excesses are 
committed at a period when intercourse ought to be left off. 

Frequent desire of micturition is the symptom that most frequently 
precedes involuntary discharges produced by venereal excesses. I 
have frequently been consulted by patients for this symptom alone, 
who had already suffered in health from unsuspected spermatorrhoea. 

The changes in the phenomena of the act also merit serious atten- 
tion. The erections, after having been frequent, long continued and 
importunate, become rare, incomplete, and of short duration; ejacu- 
lation takes place with increasing rapidity, so that at length intro- 
mission is scarcely possible. The sensations also diminish in a very 
remarkable manner, and coitus becomes very fatiguing. 

The first changes announce that irritation is being set up by the 
over excitement of the parts ; the second, that diurnal pollutions 
have already occurred. 

When these symptoms first show themselves, the disorder would, 
in many cases, be arrested spontaneously, provided the patients 
would put a check on their desires. This rarely occurs, however; 
and on the other hand, most of those who have sufficient power over 
themselves to preserve absolute continence, suffer at first from noc- 
turnal pollutions, which cause them to relapse. 

But as the economy becomes weaker, the patients are more conti- 
nent ; their desires diminish ; their nocturnal pollutions are less fre- 



VENEREAL EXCESSES. 195 

quent, and at length cease altogether, being replaced by diurnal ones. 
The patients are now strictly continent, yet derive no benefit ; and 
hence, they often believe that the disorder of their health has caused 
the diminution in their virility. Some patients have no nocturnal 
pollutions, or, at all events, such pollutions continue a very short 
time ; this arises from their tendency to constipation. The efforts 
necessary at stool bring on emissions rare at- first, but afterwards 
frequent and abundant, in spite of enemata, and even when diar- 
rhoea takes the place of constipation. In a short time these dis- 
charges occur also during the emission of urine. 

Patients rarely have any suspicion of such evacuations ; and when 
their health is so much deranged that they obtain medical aid, they 
are unable to give any exact details as to the origin of their disorder. 
According to the symptoms most apparent, therefore, the practitioner 
consulted diagnoses, chronic gastritis, commencing cardiac disease, 
threatening apoplexy, or pulmonary irritation. He bleeds, or ap- 
plies leeches and blisters : if, on the other hand, he considers the 
case one of hypochondriasis, he prescribes mineral waters, amuse- 
ments, travelling, &c. Still the disorder progresses, or at least only 
a momentary amelioration occurs ; consultations are held, but if any 
suspicion of venereal excess arise, it is always overthrown by the 
specious objection of which I have already spoken, while describing 
the effects of masturbation, viz. :— that intercourse has ceased for a 
long time, and that the health has from that period become still 
more disordered. The details given are precise and circumstantial, 
the patient has high interest in confessing all the truth, he has 
nothing shameful to hide; his statement is, therefore, received 
without hesitation by his medical attendants. Hence we may ima- 
gine the errors which are likely to arise in the treatment of these 
cases. 



( 196 ) 



CHAPTER ¥111. 

CAUSES OF SPERMATORRHOEA. 

Action of Certain Medicines. 

Ceetain medicines — as astringents, purgatives, narcotics, stimu- 
lants, and diuretics especially — may bring on conditions from which 
spermatorrhoea may arise. 

Astringents. 

CASE XLVI. 

Intermittent fever — Large doses of hark — Obstinate constipation — Diurnal 
pollutions — Symptoms of chronic gastritis, and of disease of the heart — 
The use of douches followed by rapid improvement. 

M. S , an officer, about thirty years of age, consulted me in 1828, 

for supposed disease of the heart, from which he had suffered for about 
eighteen months. He was tall, thin, and very pale; his voice husky, and 
his manners timid. On examining the cardiac region with the stethoscope, 
I found that the pulsations were rapid and tumultuous, and occasionally 
intermittent and irregular, but there was neither abnormal force nor extent 
of action, and there was no friction^ sound, nor bruit de souffle. The pal- 
pitations were much increased by active exercise, especially by mounting a 
hill, but they came on frequently whilst the patient was in a state of abso- 
lute repose, being excited by any unexpected noise, or by slight moral emo- 
tion. I was convinced that M. S had no organic disease of the heart, 

and soon after he had been told so, his pulse assumed its normal characteris- 
tics. He gave me the following history of his case. 

During the winter of 1826, whilst at Corsica, he assisted in extinguishing 
a fire which occurred during the night, and took a severe chill. Shortly 
afterwards, he suffered from a very obstinate intermittent fever, for which 
he took large quantities of bark, always in the form of boluses. From this 
period, he became subject to obstinate attacks of constipation, his stomach 
became very irritable, and his digestion disordered. Several times he had 
symptoms of chronic gastritis, which was treated by leeches, antiphlogistic 
regimen, and baths. At length palpitations and difficulty of breathing came 
on gradually, tending to create a suspicion of cardiac disease, to combat 
which, small bleedings were frequently practised, and digitalis given with- 
out benefit. The patient attributed his constipation and digestive disorder 
to the bark he had taken, and the disorder of his heart to the excitement 
he had experienced during the fire. 



ACTION OF CERTAIN MEDICINES. 197 

By a little attention, I discovered the mode in which the bark taken had 
induced the symptoms the patient suffered from; obstinate constipation 
supervening, brought on involuntary emissions during defecation; these 
were at first slight and rare, but they afterwards became more abundant, 
and after a time quite habitual, notwithstanding the frequent use of ene- 
mata. The patient had been aware of these discharges from their com- 
mencement, but he attributed them to his prolonged continence. The urine 
also frequently contained semen. On the other hand, his erections had 
diminished by degrees, and had left him entirely, together with his venereal 
desires, for more than a year. He had never committed any excess, or prac- 
tised any abuse, and had never had either blennorrhagia or syphilis. 

Cold ascending douches, iced milk mixed with lime water, and cold 
lotions on the perineum, produced a rapid improvement, and the season for 
using mineral waters having arrived, I advised the springs of Bareges. 
From that time I have had no communication from the patient. 

Palpitations in this case, as in many others that I have related, 
arose from diurnal pollutions. These discharges could only have 
been caused by straining at stool, the patient's constipation being 
evidently attributable to the prolonged use of bark in substance. 
From analogy we may suppose that many other remedies may pro- 
duce the same effects. 

Purgatives. 

I have already shown that irritation from spasmodic contractions 
of the rectum may extend to the seminal vesicles, and produce just as 
serious diurnal pollutions as those w T hich arise from mechanical com- 
pression of the same organs. Therefore, if ascarides, diarrhoea, &c, 
can excite involuntary emissions, as well as a mechanical obstacle 
to defecation does, we may easily understand that drastic purgatives, 
by irritating the rectum, may expose the patient to the same dangers 
as astringents do by bringing on constipation. Drastic purgatives, as 
is well known, act chiefly by irritating the large intestines. Spasmodic 
contractions of the rectum may, therefore, be excited, and may induce 
diurnal pollutions, the severity of which will be proportioned to the 
extent and duration of the irritation, but as this irritation usually con- 
tinues a very short time, the seminal discharges which result from it 
scarcely deserve to be considered as a disease. It is, however, easy 
to conceive that the too frequent repetition of drastic purgatives, or 
their too active character, may bring on in the rectum and neighbour- 
ing parts, a more permanent state of irritation, which may become 
habitual, and may continue after the cessation of its exciting cause. 

If, however, the abuse of purgative medicines may bring on sper- 
matorrhoea in persons not previously affected by it, it is evident that 
those who were previously affected by the disorder, must be much 
injured by their use. This fact becomes very important, because in 
almost all cases of spermatorrhoea the constipation is very obstinate, 
and the patients regard it as the primary cause of their sufferings. It 



198 CAUSES OF SPERMATORRHOEA. 

is to obviate this constipation that they seek medical advice ; and the 
symptoms of hypochondriasis and cerebral congestion they manifest, 
induce the gentlemen consulted to administer purgatives freely. The 
patients themselves constantly recur to purgatives, and although 
often worse after their use, they hope that the remote effects will 
prove more favourable. Under no pretext should the medical at- 
tendant permit the administration of any thing more active than 
mild laxatives in these cases. Indeed, it is even doubtful whether 
laxatives can be used with impunity. 

Narcotics. 

CASE XLVIL 

Frequently repeated narcotism at the age of sixteen from the vapour of to- 
bacco — Dilatation of the pupils — Vomiting — Constant headache — Consti- 
pation — nocturnal and diurnal pollutions — Impotence — Cauterization at 
the age of nineteen — Rapid recovery. 

M. S of Stockholm, short and stout, and of lymphatico -sanguineous 

temperament, enjoyed excellent health from childhood, until, at the age of 
sixteen, he entered a tobaccco manufactory in May, 1835, and was employed 
in a small room where newly made cigars were dried at a high temperature, 
At least ten thousand cigars were constantly in the stove. At first, M. 

S did not suffer any inconvenience, because the doors and windows 

of the drying room were left open; but about the beginning of November 
he was attacked by headache, which was felt principally behind the ears. 
This increased by degrees in severity and duration, and by the end of the 
winter had become constant : the patient was neither able to employ him- 
self during the day, nor to sleep by night. Leeches were applied behind 
the ears, and on the following day he was seized by general indisposition, 
frequent vomiting, as well before as after meals, dilatation of the pupils, and 
constipation. 

From this time the patient fell into a profound melancholy; he became 
excitable, timid, and incapable of any serious occupation. A seton was 
inserted in the nucha, and the application of leeches was repeated. No 
improvement took place, however, and blisters were applied behind his 
ears: these were followed by retention of urine. Soon afterwards, weakness 
of the lower extremities, loss of flesh, and pallidity of the countenance, 
were added to the patient's other symptoms. The mineral springs of 
Carlsbad and Ems, and the use of sea bathing, with cold douches on the 
head, relieved the vomiting; but the other symptoms still continued. 

In this condition, the patient came to consult me in July, 1836. From 
information received from the medical gentlemen under whose care the 
patient had been at Stockholm, Paris, &c, I imagined the sea bathing had 
been most useful of all the means previously tried. I therefore advised M. 

S to continue taking salt water baths until the end of the season, and 

consequently I did not see him again until the beginning of winter, when 
his weakness was much increased; his headaches continued unrelieved; his 
countenance was pale and livid ; his intellect very sluggish ; his memory 
his sleep short and broken, with constant drowsiness ; the pupils 



ACTION OF CERTAIN MEDICINES. 199 

extraordinarily dilated, and vision very imperfect; in fact the patient seemed 
to be still labouring under the effects produced by the cigar stove. 

The primary cause of this patient's condition could not be doubted; but 
the effects of narcotic poisons usually pass off in a day or two. In this 
case, on the contrary, the headache had been combated by various means 
for two years. I was, therefore, considerably embarrassed as to what I 
should advise, when accidentally I saw the patient's urine. I was much 
surprised to perceive an abundant deposit resembling semen, at the bottom 

of the vessel, and on questioning M. S I learned, that, although he had 

never been addicted to masturbation, and had very rarely had sexual inter- 
course, shortly after the symptoms of narcotism first confined him to his 
bed, he had experienced abundant nocturnal pollutions, which increased in 
frequency. In November, 1836, he had as many as three each night; after 
this they gradually decreased in frequency, so that he had then only three 
or four weekly; he remarked that he was always worse on the following 
day. At first these pollutions were accompanied by energetic erections, 
and lascivious dreams; but these phenomena had greatly diminished, and 
the pollutions were no longer appreciable, except by the marks left on the 
patient's linen. For a long time M. S had neither experienced vene- 
real desires nor erections, although he was only nineteen years of age. Spa 
water, iced drinks, cold lotions, &c, having produced no benefit, in the 
beginning of December I introduced a catheter. The sensibility of the 
urethra was such that I determined on cauterizing the prostatic surface. I 
had little hope of benefit arising from this operation, but a remarkable effect 
was produced. From that moment the nocturnal pollutions became more 
and more distant, and the constipation ceased spontaneously. On the tenth 
day the patient's urine was perfectly transparent, and from that time, his 
headache, which had been unsuccessfully treated for two years, disappeared 
entirely; his sight became gradually stronger, and his pupils contracted; 

his ideas became clearer; employment was sought; and M. S was 

soon able to resume his occupation. His virility returned with great en- 
ergy; during six months, obstinate erections were established every night, 
and often during the day, on the least cause of excitement, but no involun- 
tary discharges took place. These violent erections arising from the un- 
accustomed retention of the semen in its reservoirs, diminished by degrees; 
the wants became less imperious, and the functions returned to their normal 
condition. 

I have seen M. S frequently since his recovery, and I am able to 

state, that during two years his health has been perfect. In a letter which 
I have recently received from him, dated Stockholm, he informs me that the 
change of climate has not been injurious, and that he never enjoyed better 
health. He has resumed the habit of smoking, for which he felt insur- 
mountable disgust during his illness. 

This case shows very clearly the injurious influence of tobacco on 
the genital functions. The question arises, whether this influence is 
due to the action of tobacco on the cerebro-spinal system, or to the 
direct action of the agent on the spermatic organs? The first symp- 
toms manifested presented all the characteristics of poisoning by 
narcotic substances; and these symptoms were very intense, and 
much prolonged; headache, too, was constantly present, and situated 



200 CAUSES OF SPERMATORRHOEA. 

behind the ears : these circumstances might lead us to suppose that 
the pollutions were caused by some special action of the tobacco on 
the cerebellum. But cauterization alone arrested the spermatorrhoea ; 
the effects of the nitrate of silver were sudden, complete, and perma- 
nent. Impotence was, in a few days, replaced by violent and pro- 
longed erections, which diminished only after six months ; and it is 
worthy of notice, that the cephalalgia and dilatation of the pupils 
which had continued from the commencement of the narcotism, only 
disappeared after the spermatorrhoea had been relieved. 

There was, then, an idiopathic affection of the ejaculatory ducts, 
which was cured by the local action of the nitrate of silver ; and the 
cephalalgia, dilatation of the pupils, &c, were kept up by the involun- 
tary seminal discharges. The persistence of the symptoms for two 
years after the patient was removed from the influence of the tobacco, 
is thus explained. 

The mode in which certain stupifying poisons act on the economy, 
and especially the dilatation of the pupils, might induce us to believe 
that the spermatorrhoea arose from relaxation of the ejaculatory ducts; 
but in the case of M. S , the nocturnal pollutions were at first ac- 
companied by phenomena which indicated active over-excitement of 
the genital organs. The application of blisters was followed by re- 
tention of urine, and exacerbation of all the symptoms ; but if the in- 
voluntary discharges had arisen from relaxation, they would have 
been diminished by the absorption of cantharides. The excessive 
irritability present in the urethra too, especially near the bladder, 
leaves no doubt as to the existence of acute irritation in the prostatic 
portion of the canal, and this irritation would of course extend to the 
spermatic organs. Thus we may account for the remarkable success 
of the cauterization. 



CASE XL VIII. 

Nervous temperament — Repeated narcotism oetween the ages of twenty and 
twenty-two from smoking — Impotence, &c. 

I have a young man of very nervous temperament at present under my 
care, in whom nocturnal and diurnal pollutions have brought on pain in the 
loins, palpitation, difficulty of breathing, &c, symptoms which were sup- 
posed to arise from disease of the spinal cord, cardiac affection, and com- 
mencing phthisis. Among the exciting causes of these involuntary dis- 
charges, the effects of smoking occupy the chief place. The following is 
the patient's statement. 

"At twenty years of age I wished to accustom myself to smoking; but a 
day never passed without my experiencing complete intoxication, attended 
with vomiting, vertigo and trembling of the limbs. I continued the 
habit, however, and I soon began to perceive that my sight became weak, 
and that I lost my memory; my hands shook; and my digestion became 
much disordered. I noticed, also, great debility of the genital organs; my 
erections ceased; and at the age of twenty-two I found myself completely 



ACTION OP CERTAIN MEDICINES. 201 

impotent. " This patient had rarely practised masturbation, and had never 
committed any excess when he first began to smoke ; his health had, previ- 
ously, been excellent. It is, therefore, evident that the impotence, as well 
as the other symptoms, arose from the action of tobacco. Impotence at the 
age of twenty-two can only be produced by involuntary seminal discharges, 
provided there be no physical disability. In the present case, there was no 
doubt on the point, the patient himself having discovered diurnal and noc- 
turnal pollutions. 1 

The action of tobacco on those who smoke for the first time is 
too well known to require description : more or less disorder of all the 
functions, varying according to the constitution of the individual, in- 
variably arises from it; and this disorder always presents more or 
less of the characteristics of poisoning by narcotics. These effects 
go off by degrees, as the patient becomes habituated to the use of to- 
bacco, and generally after a time cease to be manifested at all. Some 
nervous and excitable individuals are unable to accustom themselves 
to the habit, as in the case just mentioned; in others again, smoking 
becomes an artificial habit, which in many cases is almost a necessity. 

But this empire of custom has its limits, beyond which, the nar- 
cotic influence reappears. In such as are not easily affected, this 
acquired habit is generally supported with impunity ; but even then, 
if it be indulged in to excess, it must after a time be injurious. 
Thus it is that the most accomplished smokers often experience 
vertigo, cephalalgia, anorexia, &c, when they have remained long in 
an atmosphere densely filled with smoke, which is then drawn into 
the lungs, and probably produces worse effects than when merely 
drawn into the mouth, or swallowed, as in smoking. 

In a word, then, if the power of habit can prevent the momentary 
effects of smoking from showing themselves, the frequent repetition of 
the use of tobacco produces more lasting effects on different organs. 
Disorder of the digestive organs is well known as occurring in in- 
veterate smokers ; that of the genital organs has not hitherto been 
noticed. 2 I believe, however, that it is by no means rare. 

Cantharides. 

I have already noticed that the application of a blister frequently 
contributes to increase or develope involuntary seminal discharges. 
But cantharides are not employed as a blistering agent only; they 
have been administered internally for the relief of impotence and to 
cure seminal discharges, which have been supposed to arise from 
atony or relaxation of the genital organs. None of the patients by 
whom I have been consulted had ever received even momentary 
benefit from the administration of cantharides ; many experienced 

1 This case being still under treatment, I have omitted its further details. 
a Many inveterate smokers among my professional friends, have mentioned to me 
the diminution of their venereal desires, as one of the effects of tobacco. [H. J. McD.] 



202 CAUSES OF SPERMATORRHOEA. 

serious increase of all their symptoms — complete impotence taking 
the place of weakness of the organs. One patient for whom an in- 
jection into the urethra of tincture of cantharides diluted with water, 
had been ordered, received no benefit from any of the means I could 
devise for the cure of involuntary discharges brought on by such 
imprudence. The unsuccessful employment of cantharides, in cases 
of spermatorrhoea, might be taken as further evidence, were any re- 
quired, that the disease does not generally arise from atony, or relaxa- 
tion, but from irritation of the genital organs. 

Camphor. 

The action of camphor is the very opposite to that of cantharides. 
It is by sprinkling camphor over blisters that the irritating action of 
the cantharides on the genito-urinary organs is avoided. Camphor 
relieves, more than any other remedy, the priapism and great pain in 
the genito-urinary organs induced by the internal administration of 
cantharides. Hence it is generally and with reason considered as an 
anti-aphrodisiac. 

I believe, then, that in moderate doses and under certain circum- 
stances, camphor may be employed with advantage in the treatment 
of spermatorrhoea : I have, however, remarked that in too large doses, 
or when continued for a long time, camphor may induce more or less 
serious and obstinate involuntary discharges. One of my patients 
who put camphor between the prepuce and the glans penis, suffered 
from such serious diurnal pollutions that his life was in danger; he 
had, however, previously suffered from involuntary discharges. 

Nitrate of Potass. 

I should not mention this preparation did I not consider it neces- 
sary to point out a grave error in the opinions generally received 
respecting its action on the genito-urinary organs. Nitrate of potass 
is supposed to possess the property of quieting the organs, and of re- 
moving venereal desires. Saline mixtures containing nitrate of potass 
are prescribed every day for the relief of the inflammatory symptoms 
in the first stage of blennorrhagia — there cannot be a greater error. 
Nitrate of potass is also regarded as a diuretic, because ordinarily it 
increases the flow of urine; and this is precisely why its sedative 
properties should be doubted. The quantity of urine can only be 
increased by stimulating the functions of the kidneys, or in other 
words by acting on them as an excitant ; when administered in too 
large a dose it produces hematuria, pain, &c. But it is not on the 
kidneys alone, that nitre produces this stimulating effect; it increases 
all inflammations of the bladder, whether acute or chronic; it is even 
contra-indicated in the most simple case of vesical irritation. 

I have seen nitrate of potass produce the same effects in diseases of 
the prostate ; it increases the stabbing and pricking pains, and the 



ACTION OF CERTAIN MEDICINES. 203 

sense of weight, which the patients always feel in that region. The 
following case shows that nitre may act in the same manner on the 
urethra. 

A merchant of Genes wishing to take a purgative, sent to a drug- 
gist for an ounce of sulphate of magnesia. By mistake an ounce of 
nitrate of potass was returned by the messenger and taken. Violent 
inflammation of the urinary passages, accompanied with a discharge 
resembling blennorrhagia, resulted, swelling took place in about the 
centre of the urethra, and when the acute stage of inflammation had 
passed off, a circumscribed induration, which obstructed the discharge 
of urine, remained. Twenty years afterwards the patient still suf- 
fered from this obstruction, for the formation of which there had 
been no other cause than the inflammation produced by the nitrate 
of potass. The patient had never had blennorrhagia, either before 
or after, and had never suffered any injury of the part. 

It appears then that the nitrate of potass acts as a stimulant of the 
whole urinary apparatus, and it is at least probable that it produces 
the same effect on the spermatic organs. I am led to this opinion 
partly by analogy, but chiefly, because more than forty of the patients 
whom I have treated for involuntary seminal discharges had taken 
nitrate of potass in some form or other, and all, without exception, 
found themselves worse afterwards. Many of them also observed 
the same effects from preparations of squill, and in fact, all other 
diuretics. 

Ergot of Rye. 

This singular production seems to act with as much energy on the 
genital organs of man as on the female uterus. In the districts 
where spurred rye is common, and the peasantry are not careful to 
separate the diseased grain from the healthy, the men show a consi- 
derable disposition to commit venereal excesses, and the women fre- 
quently abort. The population generally, also present signs of pre- 
mature decrepitude, which we can easily imagine may arise from 
involuntary seminal discharges brought on by the excesses they 
commit. 1 



Ooff, 



ee. 



The effects of coffee on the cerebro-spinal system are well known ; 
but sufficient attention has not been paid to its action on other organs. 
Taken in moderate quantities, coffee excites the bladder and kidneys, 
increases the secretion of urine, and renders its discharge more fre- 
quent. It acts in the same manner on the spermatic organs, augments 



1 M. Robert, in the Annales de The"rapeutique, relates a ca?e in which the Ergot of 
rye is said to have cured spermatorrhcea, after cauterization and other moans had 
failed. The medicine was given in pills in two grain doses, combined with one grain 
of camphor. One of these pills was taken twice a day. The details of the case, how- 
ever, are by no means clearly given. [H. J. McD.] 



204 CAUSES OF SPERMATORRHEA. 

the venereal desires, favours erections and accelerates ejaculation 
taken in excess, however, it seems to produce injurious effects. 



CASE XLIX. 

Excessive lose of coffee — Frequent and profuse discharge of urine — Noctur- 
nal, and of terwards diurnal pollutions — Impotence, &c. — Cauterization — 
Sulphuretted baths — Recovery. 

A professor, aet. thirty, engaged in a new method of tuition, had recourse 
to very strong coffee to keep himself awake, and took eight or ten cups 
every night. A large quantity of urine was secreted, and micturition was 
much increased in frequency. After a few weeks the desire of emptying 
the bladder became so frequent and imperious, that the patient was obliged 
to leave his class several times during their meeting. Soon after he suf- 
fered from constipation and disordered digestion, attended with great dis- 
charge of flatus. His intellect and memory declined, so that he became 
unable to finish his course of instruction, and sleep had left him entirely, 
although he had for some time given up taking coffee. 

On his consulting me he confessed that he had become completely impo- 
tent, after having experienced frequent and abundant nocturnal pollutions, 
which diminished by degrees, and had not appeared for three months. I 
found his urine perfectly transparent, almost colourless, and very abundant; 
there was not the least cloud perceptible, but at the bottom of the vessel 
there were numerous transparent granules, which left no doubt as to the 
existence of diurnal pollutions. 

Catheterism showed excessive sensibility of the urethra, especially near the 
neck of the bladder; and on this account I performed cauterization. The 
operation was followed by rapid improvement, and a few months afterwards 
the cure was perfected by the use of sulphuretted springs. 

It is evident that the diurnal pollutions in this case arose only from 
the immoderate use of coffee ; the first symptoms appeared soon af- 
ter, and the patient had been subjected to no other cause capable of 
producing this affection. The irritation continued for six months 
after he had left off taking coffee ; thus the effect was prolonged quite 
independently of its first cause, and in a manner which would lead 
one to suppose that it would not have ceased spontaneously. 

What passed in the urinary organs is a good index of what was 
going on in the spermatic: the secretion of semen was increased as 
well as that of urine, and its excretion also became more frequent. 
The nocturnal pollutions diminished by degrees, because they were 
replaced by diurnal ones, which became more and more frequent and 
profuse. Perfect similitude, therefore, existed between the urinary 
and spermatic symptoms ; their respective progress, and characters, 
and the extreme sensibility of the prostatic portion of the urethra, show 
clearly enough the mode in which coffee brought on spermatorrhoea. 
It is likely enough that the occasional or moderate use of coffee 
should stimulate the venereal desires, whilst they are diminished, and 



ACTION OF CERTAIN MEDICINES. 205 

even completely extinguished, by it when taken in excess. Its 
action is the same in both cases — that is to say, it excites the genito- 
urinary organs. 

I have seen many other cases in which spermatorrhoea followed the 
immoderate use of coffee, but other causes acted simultaneously, so 
that the effects could not be traced so distinctly to one single cause 
as in the case I have just related. Almost all the patients, however, 
were scientific or literary men who wished to keep up mental activity, 
in order to prolong their hours of study. Some of these patients 
recovered by the use of baths and regular active exercise combined 
with a strict regimen : others required various kinds of treatment — 
the natural sulphuretted waters being the most generally successful. 
Weak, delicate, and excitable constitutions appear most easily 
affected. 

Another circumstance having reference to coffee is worthy of 
notice. All those who have consulted me for serious nocturnal or 
diurnal pollutions had given up its use of their own accord : they 
noticed that after taking coffee they experienced agitation, disordered 
vision, involuntary contractions in their muscles, and especially a 
notable increase in the secretion of urine, and in the involuntary 
seminal discharges. 

Tea. 

Analogy leads me to suppose that tea taken in excess may produce 
the same results as coffee; I have not, however, met with any well 
marked cases illustrative of its action. 1 

There are many other agents which may excite or increase in- 
voluntary seminal discharges, but their action is not sufficiently en- 
ergetic or often enough repeated to cause serious disease. I do not, 
therefore, mention them specially here, but shall take occasion to 
comment on them as cases present themselves. 

I have now examined all the causes of involuntary seminal dis- 
charges which act from without. I have still to speak of those 
causes which may be attributed to the influence of other organs, and 
to congenital predisposition. 



1 Experience enables me to confirm M. Lallemand's opinion, as to the injurious 
effects of tea on persons affected with involuntary seminal discharges. Several of 
my patients had discovered that tea and coffee always proved hurtful to them, and 
had renounced their use before consulting me. Such patients have found no ill effects 
follow the use of cocoa. I have not, however, met with any case in which the origin 
of involuntary discharges could fairly be attributed to the abuse of tea or coffee. [H. 
J. McD.] 



( 206 ) 



CHAPTER IX. 

CAUSES OF SPERMATORRHOEA. 

Action of the Cerebrospinal System. 

Cerebellum. I have already stated that sexual ideas may precede 
the evolution of the genital organs, and always remain predominant, 
so as to produce a kind of erotic excitement quite disproportioned to 
the real wants. I may add that these precocious and excitable indi- 
viduals are most alive to the diminution of their virility. In general, 
when this diminution arises from age, it is insensible, because the de- 
sires diminish in an equal proportion. But the persons I have de- 
scribed are more sensible than others to this change, and when it oc- 
curs rapidly and prematurely, it produces a deep impression on them, 
and frequently drives them to commit suicide. 

Most surgeons have noticed the depression of spirits caused by 
amputation of the penis or testicles ; but in this respect also, there 
is a great difference between different individuals. A few years ago 
I removed the penis of a man, set. forty-five, for cancerous disease. 
He recovered, and was fit to leave the hospital, when his wife came 
to see him for the first time after the operation. During the rest of 
the day he was silent and sad, and the following morning he was 
found dead. A post mortem examination made with the utmost care, 
failed to show any appreciable lesions of important organs. 

Such striking cases of despair following the loss of the functions, 
are rare; but it is very common to see grief derange the health, and 
thus shorten the patient's days. Old people from whom portions of 
the genital organs have been removed, rarely experience this moral 
impression. I have always noticed, in such cases, that the joy of 
being cured is not broken by any regret. Whence does this indif- 
ference to the loss of virile power arise, if not from the weakening 
of the venereal desires produced by old age? 

I have had a patient, aet. thirty, in the hospital for some time, who 
received an enormous sabre wound on the nucha. A long cicatrix 
exists across the back of the neck from ear to ear. Venereal desire 
has entirely left him, and his testicles are atrophied. Erections of 
course have disappeared ; yet this patient experiences more pleasure 
at having reformed, than sorrow at the loss of his virility. He always 
jokes when speaking of the wound and its consequences. I can only 



ACTION OF THE CEREBRO -SPINAL SYSTEM. 207 

attribute this carelessness to his sexual ideas having left him at the 
same time as his virile powers. 

From these facts, then, I conclude, that the generative function 
requires not only the instruments necessary for the accomplishment 
of intercourse, but the organ in the encephalon destined to receive 
the sensations from these parts, and to direct their functions : that 
these two systems exercise a reciprocal influence over one another, 
in which influence the encephalic organ may preponderate either con- 
stantly or accidentally, according as the organ is developed prema- 
turely, and in excess, or as it enjoys a momentarily increased activity. 

Gall and his followers have regarded the cerebellum as the" organ 
of physical love and the regulator of the genital functions, and on 
this point they have shown more unanimity than on any other : this 
is not the place to discuss the correctness of their hypothesis, but I 
must say, that from my own experience, I consider it at least probable. 

CASE L. 

Masturbation — Extreme weakness of the limbs and senses — Erections excited 
by percussion of the occiput — Catheters left in the urethra — Rapid reco- 
very. 

Dubourdeaux, set. twenty-one, a soldier in the 36th regiment of infantry, 
of strong constitution, practised masturbation at the age of fourteen as 
often as three or four times a-day without much injury to his health. At 
the age of twenty, he entered the army. A few months afterwards, he 
contracted a blennorrhagia, and while suffering from it performed a long 
march. He was scarcely cured when he took another long march, bi- 
vouacking at night for about a month. Otitis occurred, and was treated 
with leeches and blisters, but ended in suppuration. After this was cured, 
the patient suffered much from noise in the ears and vertigo, and his sight 
became very weak. 

On the 21st of December, 1830, D came to the hospital of St. Eloi, 

in the following condition: itch; enlargement of the prostate; sense of 
weight in the rectum; extreme weakness of all the limbs; serous infiltration 
of the hands, legs and feet; and almost entire loss of vision. After the itch 
was cured, the paralysis of the inferior extremities increasing, issues in the 
loins were prescribed, but produced no benefit. 

When the patient came under my care, he could neither stand, nor dis- 
tinguish the numbers on the beds in his ward. He told me, that on acci- 
dentally striking his occiput, he had experienced a lively sensation resem- 
bling that produced by ejaculation, together with injection of the corpora 
cavernosa, producing more or less complete erection. He had since fre- 
quently repeated percussion of the occiput, which was always followed by 
the same phenomena; the voluptuous sensation induced seemed to pass 
through the whole length of the spinal cord, to the extremity of the sacrum. 
Some circumstances leading me to believe that the patient abused this dis- 
covery, and practised manoeuvres he did not admit, and the swelling of the 
prostate at the same time rendering the discharge of urine difficult, I left 
catheters in the bladder, increasing their size gradually, and taking care to 



208 CAUSES OF SPERMATORRHEA. 

withdraw them as soon as sufficient inflammation had been excited, and to 
replace them when the pain in the urethra had subsided. 

The result soon convinced me that my suspicions had been correct. 
By degrees the paralysis of the lower extremities, the oedema of the hands, 
and the weakness of vision, were relieved. After introducing the catheter 
six times in as many weeks, the patient had recovered his strength, stout- 
ness, and the free exercise of all his functions. He left the hospital a few 
days after, confessing his errors and promising not to repeat them. 

From the first information given by this patient, I thought that 
the attack of otitis had probably produced some chronic affection of the 
brain or its membranes, but the sequel showed that the almost per- 
fect paralysis of the lower limbs, the swelling of the hands, and 
other symptoms, exclusively arose from masturbation. I have al- 
ready mentioned the advantages derivable from the presence of a 
catheter in the urethra, in checking masturbation ; but in the present 
case, a very remarkable circumstance offered itself, viz., the influ- 
ence exercised on the genital organs by percussion of the occiput. 
The effects of this procedure were so constant, that the patient was 
able to procure himself erections at will, and to give himself up to his 
passions without restraint. 

CASE LI. 

Sickly childhood — Nervous temperament — Masturbation rare — Coitus still 
more so — Symptoms of aneurism and gastritis — Nocturnal pollutions — 
Predominance of erotic ideas — Tension at the nucha — The application of 
cold lotions to this region followed by considerable improvement. 

A tax-gatherer, get. thirty -four, of nervous temperament, whose childhood 
had been very delicate, from his having suffered from digestive disorder, 
with frequent vomiting, consulted me. He had practised masturbation oc- 
casionally about the age of sixteen, and at a later period had had sexual 
intercourse, but never more frequently than three or four times a week. 
At eighteen years of age, he suffered from palpitation of the heart, attended 
with oppression of breathing, pain in the stomach, and involuntary muscular 
contractions. These symptoms gave rise to suspicions of aneurism, gastri- 
tis, &c; in consequence of which, frequent abstraction of blood, both locally 
and generally, and the use of blisters and issues, were prescribed : with the 
exception of the issues, these means all proved injurious. The blisters evi- 
dently seemed to fat our the occurrence of nocturnal pollutions, which took 
place three or four times a week about this time, taking the place of 
voluntary emissions. Shortly before he consulted me, this patient attempted 
sexual intercourse by the advice of his physician, but found himself much 
worse afterwards. All the precautions recommended to prevent the return 
of the nocturnal pollutions had also proved unsuccessful, and the patient 
had remarked that these were more debilitating in proportion as they took 
place with less signs of erection or feelings of pleasure. Their effects were 
often felt for several days. 

The extraordinary presence of erotic ideas in this patient struck me 
forcibly. Notwithstanding the small development of the genital organs, 



ACTION OF THE CEEEBRO-S PINAL SYSTEM. 209 

nothing could remove lascivious images from his imagination; they were pre- 
sent during the most serious study. In vain he gave up theatres and amuse- 
ments; in vain he had recourse to serious books, and religious or scientific 
discussions ; he was constantly assailed by libidinous thoughts, which pre- 
sented themselves under a variety of forms, and were ever present in his 
dreams. He experienced also, an habitual sense of tension and uneasiness 
in the posterior and inferior region of the head. Of all the means employed, 
cold lotions applied to this region alone produced any notable diminution in 
the frequency of the nocturnal pollutions ; but this effect was never of long 
duration. 

In this patient the causes by no means tallied with the serious 
effects produced, or with the persistence of the disease. Numbers 
have practised masturbation and coitus much more frequently with- 
out experiencing any ill effects. On the other hand, the constant 
presence of erotic ideas showed an activity of the genital instinct, 
which was by no means in relation with the condition of the genital 
organs. The sensation referred to the nucha, and the effects of cold 
lotions applied to this part seem to indicate that the affection was 
produced, or at least kept up, by abnormal excitement of the cere- 
bellum. 

In several cases of involuntary seminal discharges, I have found 
the patients complain of habitual heat, dull pain, and sense of ten- 
sion in the occipital region ; sometimes accompanied with pulsation 
of the arteries. One of my patients experienced a nocturnal pollu- 
tion whenever his head rested on a soft pillow. I must admit, that 
in such cases I have not obtained much success by using applications 
to the nucha and its neighbourhood; indeed, I have only once seen 
temporary improvement result from this treatment. 

On the other hand, these symptoms are much more rare than any 
others of which I have hitherto spoken. Thus, for example, symp- 
toms which we may refer to the brain, are much more frequently 
presented. There are few patients who do not experience diminu- 
tion of memory and intellect, pain in the frontal region, pulsation in 
the temporal, and weight in the anterior and lateral parts of the head, 
with attacks of vertigo, dazzling of sight, and cerebral congestion: 
some even have serious falls; and the integuments of the face are 
much more frequently red and burning than those of the nucha. 
Symptoms of chronic stomach disorder are still more common, and 
it is by no means extraordinary to see accidental irritation of the 
stomach increase or re-excite involuntary seminal discharges. The 
influence of the cerebellum in causing spermatorrhoea is, therefore, a 
subject which requires further research, with varied and numerous 
cases, in order for it to be properly understood. 

In such cases my experience leads me to recommend the applica- 
tion of ice and leeches to the nucha, when particular symptoms are 
observed in this region, or when other means have failed. But in 
order to judge the effects of these remedies fairly, it is necessary to 
abstain from all other treatment at the same time, and to guard against 
14 ° 



210 CAUSES OF SPERMATORRHOEA. 

preconceived opinions. Exaggerated opinions have done more in- 
jury to the truth than the most violent opposition. 

It is impossible, for instance, to admit, with Gall, Voisin, Londe, 
Chauffard, &c, that we should always direct our remedies towards 
the cerebellum in cases of satyriasis, nymphomania, &c. ; or that the 
cerebellum is always the origin of the phenomena which take place 
in the genital organs. Such an assertion scarcely requires a serious 
consideration. It is hardly necessary to refer to the powerful and 
immediate influence exercised over the thoughts, dreams, venereal 
desires, erectile tissues, — indeed, over all the functions, and all the 
organs of the economy, by the presence of well formed semen in its 
reservoirs. Such effects are seen daily, and constantly, and have 
been well understood for a long time. Ascarides, by causing irri- 
tation in the rectum, suffice to excite long-continued erections, even 
in children, and to incline towards abuses and excesses; or, by acting 
directly, to bring on debilitating involuntary emissions. Sebaceous 
matter retained between the prepuce and glans, may produce the 
same effects. In women, excision of the clitoris takes away the pas- 
sion for masturbation. It is well known too, that the presence of an 
eruption on the labia often excites nymphomania. How do these facts 
accord with the opinions of those who would refer all such influence, 
and would direct all their remedial measures, to the cerebellum ? 

There are other arguments which I regret to see incessantly 
brought forward to prove the action of the cerebellum on the genital 
organs. As an example of these, I may mention the effects which 
sometimes accompany apoplexy of this organ. 

Gall well explains the proneness to masturbation in such hydro- 
cephalic children as attain the age of puberty, by remarking that 
this affection, acting only on the brain, allows the cerebellum a pre- 
dominating influence. This deduction seems correct, and may be 
applied with just as much truth to idiots and Cretins. But apoplexy 
of the cerebellum instantly abolishes the function of the part attacked : 
to explain pathological erections by this alteration, and to conclude 
that the cerebellum is the exciting organ of the genital functions is, 
therefore, an evident contradiction. Instead of laying stress on such 
facts as these, Gall and his followers should have regarded them as 
serious objections to their system; they should have sought to dis- 
cover how erections could take place in spite of the greater or less 
destruction of the cerebellum ; they would then have seen that such 
erections are less common than they are supposed to be in cerebellar 
apoplexy, and that they much more frequently accompany injuries 
of the spinal cord, &c, — circumstances .which the adversaries of 
phrenology have taken care to remark: so true is it, that truth makes 
itself known by all ways. 

The exaggeration and false reasoning that have obscured all dis- 
cussions relative to the true seat of the genital instinct must not, how- 
ever, induce us to forget the importance of pathological facts. What 
I have said, should make the profession take into consideration the 



ACTION OF THE C EREBE 0-8 PIN AL SYSTEM. 211 

influence the cerebellum may possess in causing involuntary dis- 
charges of which they are unable to discover the cause, especially 
when such discharges are accompanied with special symptoms re- 
ferred to the occipital region. 

Spinal Cord. 

I 

The opinion has been given, that diurnal pollutions are sometimes 
the cause, and sometimes only a symptom of atrophy of the medulla 
spinalis. The following case, which has come under my observation, 
I think throws some light on this subject. 

A private in the engineers wishing to get out of his barracks to 
visit a female, fell from a great height on his buttocks. Serious con- 
cussion resulted, but no fracture. Notwithstanding bleeding, leeches, 
cupping, issues, &c, the lower extremities remained paralyzed. 
After a time, however, galvanism restored slight motion, and obscure 
sensibility. Still the glans, the prepuce, and skin of the penis and 
scrotum, remained completely insensible. Pinching, and pins driven 
into them were unperceived by the patient. Catheterism, which at 
first was frequently necessary, never induced complaints. But 
chronic vesical catarrh supervening, I cauterized the bladder and its 
neck, and this operation gave just as much pain as in other patients. 

The same phenomena followed. At first the urine was sanguino- 
lent and thick, but soon lost this appearance, and was passed with 
greater force and facility. Whilst treating this patient, I often found 
the penis in complete, and indeed remarkable erection. I mentioned 
this to the patient, who told me that he often suffered from this state 
of priapism, which he found very disagreeable on account of the ob- 
stacle which it formed to the discharge of urine. In order to relieve 
himself, he had several times tried masturbation, but had never been 
able to procure ejaculation, notwithstanding the erection was perfect, 
and he had persevered in his manoeuvres. He experienced no plea- 
sure, and only attempted it in the hope of relieving the priapism. 
Having one day obtained permission to leave the hospital, he visited 
the female, to see whom he had scaled the barrack walls in so unfor- 
tunate a manner. He passed several hours with her in almost con- 
tinual connexion, without being able to procure ejaculation, and 
without experiencing the least sensation. On the other hand, all his 
functions were well performed, with the exception of slight costive- 
ness ; he gained flesh daily, and his moral faculties were not affected ; 
abundant nocturnal pollutions took place at long intervals, and were 
preceded by erotic dreams, but accompanied with little pleasure. 

This case shows clearly the special influence of the spinal nerves 
in contra-distinction to that of the branches of the sympathetic, dis- 
tributed to the different parts of the genital apparatus. In fact, in 
this patient, all the phenomena dependent on the cerebro-spinal ap- 
paratus were abolished, whilst the others had not experienced the 
least change. Voluntary ejaculation was impossible, because the 



212 causes or spermatorrhea. 

penis Lad lost all sensibility, and consequently, all its influence oyer 
the seminal vesicles. This confirms what I have already stated re- 
specting the difficulty of ejaculation caused by intoxication or nar- 
cotism. It is sufficiently evident, that alcoholic drinks, &c, when 
the stupor is perfect, may retard ejaculation, or even render it im- 
possible, although erection may be complete. In this patient, there 
was constant and energetic priapism, which was not accompanied by 
any lascivious ideas, because it was produced directly by the accu- 
mulation of semen in its reservoirs, without any sensation being 
transmitted to the encephalon, at least during the waking state. But 
during sleep, all the senses being inactive, as well as the cerebro- 
spinal system, and the nerves derived from it, sensations transmitted 
by the branches of the trisplanchnic, might awaken images and as- 
sociations of ideas, as well as produce from time to time lascivious 
dreams and nocturnal pollutions— -proving that these phenomena are 
directly under the control of the great sympathetic. 

On the other hand, this patient never had diurnal pollutions, not- 
withstanding the complete paralysis of the nerves given to the genital 
organs by the spinal cord; we may conclude, therefore, with every 
show of reason, that involuntary diurnal pollutions cannot be symp- 
tomatic of atrophy of the spinal cord, or of the nerves arising from it. 

I do not imagine that the same thing holds good as regards irrita- 
tion or excitement of the spinal cord, which may be transmitted to 
the genital organs by the nerves which are distributed to them. I 
believe that serious seminal discharges may arise from this cause — 
founding my opinion on the injurious influence produced in some 
cases by issues or cutaneous eruptions in the lumbar region, as well 
as by the manner in which lying on the back produces nocturnal 
pollutions, and the incontrovertible benefit derived in some cases of 
spermatic discharges, from douches and cold applications on the lower 
portion of the spinal column. I have, however, no records of any 
case in which this spinal irritation was sufficiently marked and isolated 
to merit its being related here. 



CHAPTEE YIII. 

CAUSES OF SPERMATORRHOEA. 

Congenital predisposition. 

The causes of which I have yet to speak are very various, and for 
the most part, sufficiently obscure. The facts which I shall have to 
relate are even less known than those I have treated of hitherto. 
They are more difficult of appreciation, and probably they present 



CONGENITAL PRE-DISPOSITION. 213 

also greater interest. They refer, in fact, to unfortunates whose fu- 
ture is seriously affected by causes entirely independent of their con- 
duct, but which weigh down all their lives like a kind of fatality. 
They differ from all the causes I have hitherto examined, by being 
inherent in the organs of generation themselves. But they may pre- 
sent themselves under very different aspects ; they may arise either 
from vicious conformation, from a condition of original debility, from 
a congenital relaxation, or irritability of the organs, or from heredi- 
tary predisposition. 

In examining these various congenital causes, I shall, as before, 
pass from the more evident to the more obscure; and I shall take 
this opportunity of commenting on the characters, by means of which, 
we can sometimes estimate, with some degree of precision, the powers, 
so unequal, of the generative organs. This is of considerable import- 
ance in the study and treatment of involuntary seminal discharges* 

Sebaceous Matter. 
CASE LII. 

Natural Phimosis — Frequent nocturnal pollutions from the age of puberty 
— Abundant and fetid sebaceous secretion between the glans and pre- 
puce — Circumcision at the age of twenty-three followed by immediate 
relief 

M. B set. twenty-three, of nervous temperament, having enjoyed 

good health up to the period of puberty, from that time presented a yellow 
and leaden appearance, with sunken eyes, forehead covered with acne punc- 
tata, and timid manners. For a long time he had appeared as if plunged 
into deep melancholy, and constantly sought solitude. He was restless, but 
was unable to bear fatigue. Digestion was difficult, and his intellect dull. 
This disorder had lasted four or five years, but had increased sensibly during 

the last year before M. B came to consult me. I suspected him of bad 

habits, but he assured me that he had escaped them from want of desire, and 
that he had never had sexual intercourse. From the period of puberty, how- 
ever, M. B had been subject to nocturnal pollutions, the frequency and 

abundance of which had progressively increased; and in spite of the means 
generally recommended in such cases, pollutions occurred every night, and 
sometimes two or three times during the night. He had never noticed asca- 
rides in his fseces, nor experienced itching at the anus. 

I was uncertain to what cause to attribute these pollutions, when on exa- 
mining the genital organs, I noticed that the opening of the prepuce was 
very narrow, and that abundance of sebaceous matter escaped. Pressure made 
from behind forwards produced the discharge of a large quantity of matter of 
milky appearance and considerable fetor. I concluded, therefore, that the 
natural phimosis, by preventing the discharge of the sebaceous secretion, was 
the cause of involuntary discharges, and in consequence, recommended cir- 
cumcision, which was performed immediately. I found a large quantity of 
sebaceous matter resembling soft cheese in colour and consistence, and of a 
very disagreeable smell, covering the surface of the glans, and especially col- 
lected round the corona glandis. The glans itself was vividly red, almost 



214 CAUSES OF SPERMATORRHOEA. 

entirely deprived of its epithelium, extremely sensitive — the least friction 
causing a discharge of blood. 

From this moment, M. B passed a fortnight at a time, and sometimes 

longer, without having nocturnal pollutions, which afterwards only arose 
from spermatic plethora. A rapid change took place in his health and habits, 
so that at the end of a month he was scarcely recognisable. 

This case is the most simple and perfect of the kind that I have 
met with. It shows clearly enough, that natural phimosis may be 
sufficient to bring on pollutions, for the patient had never practised 
masturbation, nor had sexual intercourse. It was evident that the 
prolonged retention of the sebaceous matter gave it an acrid and 
irritating character — the constitution being free from humoral dispo- 
sition, or cutaneous affection. On the other hand, the genital organs 
were well developed, and the health was not very seriously affected, 
so that excision of the prepuce produced a sudden and durable effect. 
I have seen many analogous cases, but in these the effects of this 
mal-conformation of the prepuce in causing involuntary discharges, 
were not so marked, because other causes were usually superadded. 
Thus, in one case ascarides were present at the same time, and in 
many others, the patients had practised masturbation. Masturbation 
in such cases was generally excited spontaneously, and it is likely 
enough, that the phimosis should contribute to this result. Irritation 
of the glans by sebaceous matter excites importunate erections and 
titillations, which attract the attention of children to the parts, and 
induce handling and friction. We may, therefore, attribute the 
spontaneous occurrence of masturbation in young children, who are 
thus formed, to the too long continued presence of the sebaceous 
matter between the glans and prepuce. Numerous examples have 
left me no doubt on this subject. 

The following case, which is still under my care, presents remark- 
able circumstances. 

CASE LIII. 

Natural phimosis — Erections at the age of eight — Attempt at coitus at nine 
— Vesical catarrh — Diurnal pollutions — Paraplegia, &c. 

A peasant consulted me for his son, set. fifteen, who, for two years, had 
experienced a constantly increasing paralysis of the lower extremities. On 
his sides and loins were marks of numerous issues which had been tried 
during two years. Large excoriations had formed on the sacrum and tro- 
chanters. 

On examining the genital organs, I noticed that the prepuce was very nar- 
row; and on pressing it to get rid of the sebaceous matter which presented 
at its orifice, the penis became erect. I learnt from the parents that this 
boy had erections at the age of eight; and that at nine years of age, he had 
been found attempting coitus. The boy himself admitted that the itching 
with which he was tormented led him to rub the genital organs, and thus in- 
duced manoeuvres which he had since continued. 



CONGENITAL P R E-D I S P S I T I N. 215 

The first symptom that presented itself was frequent desire of micturition, 
and this was followed in about a year by complete incontinence of urine. 
In the course of the second year, the patient's legs grew weak; he lost his 
intellectual capacity ; digestion became disordered; diarrhcea came on; and 
the discharge of urine and faeces caused excoriation of the skin. Salt and 
aromatic baths, tonics, excitants, &c, had been just as useless as issues. 
The cause of the disease was unsuspected. 

Masturbation had become very rare, but the urine was thick, muddy, and 
very fetid — so much mucus was passed, that I was unable to make sure of 
its containing semen- — but the patient had constant pollutions at stool. 

I first performed ablation of the prepuce; and eight days after, I caute- 
rized the bladder and surface of the prostate. A month afterwards, the 
urine was perfectly transparent, and presented a healthy appearance ; it was 
no longer passed involuntarily. Sensibility of the skin of the lower extremi- 
ties had returned. Improvement was here arrested, however, and I lost sight 
of the patient. 

This patient had never been subjected to the influence of bad ex- 
ample, and had always been well cared for. He explained clearly 
how he was led to practise masturbation ; and circumstances gave 
an appearance of truth to his recital. It is, then, to the irritating 
action of the sebaceous matter that we must attribute his unfortu- 
nate condition. 

Natural Phimosis. — In the venereal wards at the hospital St. Eloi, 
numerous soldiers present themselves yearly for attacks of balanitis, 
which they consider bastard clap. Certainly, in many of these cases, 
the discharge arises from the action of blennorrhagic virus ; blennor- 
rhagia is present at the same time, and both discharges have super- 
vened on impure connexion. But in many other cases, the inflam- 
mation arises from the acridness of the sebaceous matter, caused by 
its too long retention between the glans and prepuce. Such cases of 
balanitis are rarely observed, except in persons whose prepuce is too 
contracted to permit the glans being uncovered. Sometimes they 
occur as the result of drinking or of fatigue, without any connexion 
having taken place. These inflammations rapidly disappear when 
the prepuce has been removed, or even when the parts are kept con- 
stantly washed — leaving no doubt as to their true cause. 

In many cases, when I have practised circumcision for congenital 
phimosis, I have found the glans and prepuce adherent to a greater 
or less extent, especially in the neighbourhood of the corona glandis, 
around which the sebaceous matter accumulates most readily, and 
whence it is most difficult of removal. In some cases I have seen 
these adhesions extend over half the extent of the glans, and they 
were always situated in the parts farthest from the preputial orifice. 
In a few cases, I have only found the point of the glans free from 
adhesions. Such adhesions could only be established by the destruc- 
tion of the mucous linings of the parts — these linings never becoming 
adherent so long as they retain their mucous structure. The inflam- 



216 CAUSES OF SPERMATOREKEA. 

mation of the surfaces of the glans and prepuce must therefore have 
been sufficiently severe to cause superficial ulceration. 

I have frequently seen the surface of the glans excoriated, with 
elevated papillae and drops of blood exuding from them; at other 
times I have found the glans deprived of epithelium with excavated 
ulcers. In such cases, the corresponding surface of the prepuce was 
always more or less excoriated, or ulcerated also ; and these excoria- 
tions were often accompanied with inflammatory swelling of the lym- 
phatic glands in the groin. These ulcerations have been confounded 
with chancres; but their edges are thinner, and they are less deeply 
excavated; the neighbouring parts too, are covered with a layer of 
sebaceous matter of caseous aspect and fetid smell. Such ulcerations 
disappear after the removal of the prepuce, their appearance be- 
coming changed even in twenty-four hours. Fomentations and 
cleanliness do all the rest. 

Such is the condition which the parts present in cases of recent 
balanitis ; and these are the inflammations and ulcerations that cause 
more or less extensive adhesions of the prepuce to the glans ; such 
adhesions are generally cellular, but sometimes fibrous or even carti- 
laginous, according to the severity and frequent repetition of the 
inflammation. 

Various degrees of induration also result, according to the intensity, 
the duration, and the frequency of the phlogosis. Thus, I have often 
found the mucous membrane hardened, thickened, and covered with 
numerous papillae, sometimes fibrous or even cartilaginous, with three 
times its natural thickness. I have also met with cases in which the 
prepuce has become cancerous. I have operated in several cases of 
cancer of the penis too, which certainly arose from no other cause. 
The patients were generally peasants between fifty and sixty years 
of age, who had never known other than their wives, but who had 
frequently suffered from balanitis, attended by abundant discharge, 
swelling of the prepuce, and excoriation of its opening, which was so 
contracted as to prevent the passage of the glans. I have seen one 
case also, in which balanitis, irritated by a forced march, and the 
abuse of alcoholic stimulants, passed into gangrene, by which the 
greater part of the glans was destroyed. 

Such have been the accidents which I have observed in those 
whose prepuce was too narrow to permit the glans being uncovered; 
accidents which I can only attribute to the long retention of the 
sebaceous matter in a kind of cul de sac, into which a certain quan- 
tity of urine passes every time the patient makes water. 

But natural phimosis is not the only cause of the injurious effects 
produced on the genital organs by the sebaceous matter; as the fol- 
lowing case will show. 



CONGENITAL PRE-DISPOSITION. 217 



CASE LIY. 

Very long prepuce — Badly developed genital organs — Childhood delicate- — 
Incontinence of urine — Sebaceous discharge from the orifice of the pre- 
puce at the age of ten — Nocturnal pollutions increasing in frequency — 
Hypochondriasis — Loss of memory and failure of intellect — Constipation 
— Diurnal pollutions — Constant application of lotions attended by relief 
— Circumcision at the age of twenty-eight, followed by cure. 

M. J. B , of Amsterdam, of delicate constitution and lymphatic tem- 
perament, was subject during childhood to incontinence of urine, and always 
suffered from frequent desire to make water. About the age of ten, a 
whitish matter formed, and was discharged from underneath the prepuce; 
after which erections occurred, and were soon followed by emissions: a very 
disagreeable smell accompanied the preputial discharge. The seminal dis- 
charges increased as the patient's passions were roused, and he grew sad, 
silent, discontented, and constantly occupied with the origin of his disorder. 
He imagined that the whitish discharges arose from venereal disease, although 
he had never had connexion. His health became much disordered, and at 
the age of nineteen he mentioned his condition to his medical attendant. 
Lotions were prescribed, which removed the sebaceous matter and produced 
considerable improvement in the patient's health. 

M. B 's bowels became constipated, however, and he perceived that 

he passed semen while at stool, in consequence of the efforts necessary. 
The nocturnal pollutions diminished in frequency, but still occurred occa- 
sionally. 

When M. J. B consulted me in November, 1836, he presented the 

following condition: — small stature, limbs slight and chest narrow; skin 
fair and soft; hair white and thin; face very pale; manner timid and em- 
barrassed; hesitation; habit of stammering, arising from disorder in the in- 
tellect and loss of the memory; genital organs remarkably small; penis 
small and short, hidden among long scanty white hairs; prepuce very long, 
forming numerous folds in front of the glans; surface of the glans covered 
by a thin layer of sebaceous matter, notwithstanding the utmost cleanliness 
on the part of the patient; scrotum compressed and much folded, containing 
only the right testicle, about the size of an almond, the left being felt in the 
inguinal canal attached to a portion of omentum. No spinal curvature 
(which the patient had feared,) his mistake arising from the projection of 
the hips and pelvis which resembled those of a woman. 

I removed the prepuce entirely in order to put an end to the influence of 
the sebaceous matter on the glans ; catheterism not giving much pain, I did 
not consider cauterization necessary; but in order to give tone to the 
organs I left a catheter in the bladder for an hour or two at a time once a 
week, and ordered the free use of cold douches to combat the constipation. 
The patient's temperament being exceedingly lymphatic, I afterwards pre- 
scribed three or four aromatic baths weekly, with the habitual use of Spa 
water. 

These means lengthened the periods between the nocturnal pollutions, 
diminished the constipation, and lessened the involuntary discharges that 
took place when the efforts at stool were considerable. Acupuncture of 
the perineum and prostate produced more rapid and decided effects. After 



218 CAUSES OF SPERMATORRHOEA. 

this had been practised, sixteen days were passed without nocturnal pollu- 
tions, and the efforts at stool did not cause any seminal discharge. By de- 
grees the patient's face became more healthy-looking and animated; his 
strength and energy returned; his character regained its boldness and 
gaiety; erections became frequent and energetic; and his health altogether 

having become as good as could be desired, M. B returned to his 

home. 

Six months afterwards I accidentally met M. B in Paris : he frequented 

theatres and amusements, and went into society; indeed his character was 
quite changed. 

I have seen few men so badly developed as M. B . It was 

certainly to the poor development of the penis that the length of the 
prepuce was attributable — the skin of the penis not being longer 
than natural, though it proved exuberant when compared with the 
parts it was intended to cover. The scrotum presented the same 
appearance as the prepuce, and from the same cause. It was re- 
tracted towards the pubes, and formed numerous and deep folds, — 
the testicles not being more developed than in a child of eight years ; 
the left one, too, was entangled in the corresponding inguinal canal. 
This slow descent of the testicles is a sign of weakness, which cor- 
responded with their small dimensions. 

The incontinence of urine to which M. B was long subject, 

announced debility of the urinary passages, from which no opinion 
could be drawn in favour of the power of the spermatic. The con- 
nexion between the two systems showed itself to the last — a frequent 
desire to micturate accompanying the seminal discharges. 

The fancied deformity of the spinal column was merely a projec- 
tion of the hips, which gave the form of the female sex — a conforma- 
tion which I have frequently observed with extreme weakness of the 

genital organs. I should notice that M.B was born and brought 

up in Holland ; that his childhood was delicate, and that his tempe- 
rament was very decidedly lymphatic. 

It may be readily conceived, that w T ith these predispositions M. 

B escaped all bad habits, and that he continued continent; yet 

at ten years of age he was subject to frequent nocturnal pollutions. 
How was this ? The pollutions seem to have arisen from the stimu- 
lating influence of the sebaceous matter collected between the pre- 
puce and glans. The improvement derived from the use of lotions 
at the age of nineteen corroborates this opinion. These means, 
however, only gave momentary relief; circumcision at the age of 
twenty-eight, did not suffice alone to bring about perfect re-establish- 
ment, in consequence of the debility of the genital organs, and the 
obstinate constipation which had excited diurnal pollutions, added to 
the difficulty of breaking a habit which had continued eighteen years. 
Aromatic baths, Spa water, frequent douches, and lastly, acupuncture, 
were employed to combat these complications. The remarkable 
effect of the last remedy shows that habit had much to do with keep- 
ing up the pollutions. 



CONGENITAL PRE-DISPOSITION. 219 



CASE LV. 

Very long prepuce — Badly developed erectile tissues — Abundant secretion 
of sebaceous matter — Seminal emissions induced by horse exercise, and 
afterwards by incomplete intercourse — Marriage unconsummated during 
five years — Diurnal pollutions — Circumcision followed by rapid cure. 

M. C 3 of robust constitution, born in Switzerland, the son of healthy 

and strict parents, was early imbued with rigid moral and religious princi- 
ples. At the age of eighteen he experienced for the first time, while on 
horseback, an abundant seminal emission, and he afterwards frequently had 
recourse to the same means to excite a return of the voluptuous sensations, 
against which he had never been warned. After a time, too, he found 
a means of procuring them by other manoeuvres. Still he did not prac- 
tise these abuses very often, often abstaining for a month or two at a time; 
and consequently his health was uninjured. At the age of twenty-five, 
having never had sexual intercourse, he married. Four years afterwards, 

being disappointed at not having children, M. C consulted his medical 

attendant, who, by dint of questioning, discovered that the marriage had 
never been properly consummated. Frequent and abundant emissions had 
indeed taken place, even with much facility ; but they had been produced 
by simple pressure, or at most, by slight external friction. Unfortunately 

for M. C his erections, which had been very energetic at first, had 

progressively diminished, so that he was now quite unable to profit by the 
instructions he received. 

Ferruginous preparations, friction on the loins, cold injections into the 
urethra, and various tonics were employed, and did more harm than good. 

M. C was, therefore, sent to consult me in July, 1837, five years after 

his marriage. 

He was then thirty years of age, tall, strongly built, and apparently in 
excellent health; he experienced, however, a degree of debility in his hands 
and legs; all his functions, with the exception of those belonging to gene- 
ration, were well performed. The penis was remarkably small; the pre- 
puce, on the contrary, much longer than the erectile tissues, formed nume- 
rous folds in front of the glans, and was lined with a large quantity of se- 
baceous matter; several thick layers of it were also accumulated on the sur- 
face of the glans, which was much injected and extremely sensitive. The 
urine always contained a more or less abundant flocculent deposit, in which 
I invariably discovered spermatozoa. 

I immediately performed excision of the prepuce, and a few days after- 
wards, the urine became transparent, and the erections reappeared — weak 
at first, but soon acquiring energy. The object of marriage was at length 
properly fulfilled. 

I have recently learnt that M . C is about to become a father. 

The abuses to which this patient was impelled spontaneously were 
too rarely practised to have had any power in producing this singular 
affection ; besides, immediately after his marriage his erections were 
frequent and active enough, but ejaculation took place too rapidly: 
by considering this in connexion with the fact of seminal emissions 



220 CAUSES OF SPERMATORRHEA. 

having been excited by horse exercise, we must arrive at the opi- 
nion that the penis was excessively sensitive. This could not be 
attributed to predominance of the erectile tissues, these being, on the 
contrary, remarkable for their paucity; some irritating cause must, 
therefore, have excited and kept up the abnormal sensibility of the 
glans, and this irritation could only arise from the sebaceous matter 
on its surface being altered by too long retention. This opinion is 
strengthened by the simple excision of the prepuce sufficing to arrest 
the diurnal pollutions, and to bring about complete performance of 
the genital functions. 

Exuberant Prepuce. — In the cases I have just related the genital 
organs were remarkable for their small development. The corpora 
cavernosa were small and short, and were surmounted by a very 
small glans, the whole forming a kind of vermiform appendage in 
front of the pubes, composed almost entirely of corrugated skin, and 
nearly hidden among long and scarce hairs. The scrotum presented 
an analogous disposition ; it was retracted towards the pubes, and 
formed numerous and deep folds. The testicles were remarkably 
small, and in the 54th case, one of them had not passed the inguinal 
canal. The extreme length of the prepuce, as well as its numerous 
folds, must be attributed to the small development of the erectile 
tissues; ^d the numerous and deep folds of the scrotum arose from 
the smallness of the testicles. These circumstances are, therefore, 
frequently met with together, and very often congenital hernia, vari- 
cocele, or great width of the pelvis, with the rounded form of the 
female, are superadded. 

All the patients of this kind that I have met with have possessed 
a delicate constitution, and had passed a sickly childhood; they were 
generally, too, of nervous or lymphatic temperament. Most of them 
had received a very strict education. 

Still, these patients have generally suffered from nocturnal pollu- 
tion arising, without any kind of excitement, about the ages of ten or 
twelve ; or they have been led spontaneously to commit serious 
abuses before the age of puberty ; (one of my patients committed 
venereal excesses at a very early age ;) and they all fell promptly 
into a state of complete impotence, arising from diurnal pollutions. 

The premature erections from which these patients suffered are 
certainly not attributable to the rudimentary condition of the genital 
organs, nor to their sickly infancy; the circumstances in which 
they were placed, too, had no influence in causing abuse; and the 
patients did not suffer from ascarides. The premature activity, 
therefore, arose from simple local excitement of the penis ; and this 
was not produced by the presence of semen, because in many cases 
the testicles had not begun to secrete. The accumulation of the se- 
baceous matter around the glans, is the only sufficient explanation of 
this habitual abnormal irritation; and this opinion is strengthened by 
the more or less frequent occurrence of discharges, and by the ha- 
bitual excoriation of the opening of the prepuce; by the frequent 



CONGENITAL PRE-DISPOSITION. 221 

attacks of inflammation, by the tenderness of the glans, and the 
injection of its surface. The remarkable effects produced by clean- 
liness, and by excision of the prepuce, leave no doubt on this 
subject. 

Such persons, then, as have the prepuce very long and folded in 
front of the glans, are exposed quite as much as those who have a 
natural phimosis to all the inconveniences which arise from the col- 
lection and putrefaction of the sebaceous matter; and the irritation 
in both cases extends to the urinary and spermatic organs. 

There is, however, one point of difference between natural phi- 
mosis and exuberant prepuce, which it is of importance to notice. 
Excessive length of the prepuce generally depends on paucity of 
erectile tissues, and is frequently coincident with rudimentary testi- 
cles ; it results, therefore, that in this case the irritation acts on weak 
and mal-formed organs, which are easily affected by the abuses or 
excesses which it excites: the involuntary seminal discharges that 
occur in these cases are, therefore, very difficult of cure. In cases 
of natural phimosis, on the other hand, circumcision alone generally 
suffices to bring about a cure, because the narrowness of the pre- 
puce does not, like its exuberance, accompany a small development 
of the genital organs. 

In cases of exuberant prepuce, things are not so simple, for it does 
not suffice to remove the part, or even to relieve the irritation of the 
urethra and bladder; congenital debility of the genito-urinary 
organs remains, which it is often very difficult to remove by tonics, 
on account of the susceptibility of the tissues arising from their long 
irritation ; this debility, too, arises from the primary organization of 
the parts, and is consequently difficult to cure entirely. Such pa- 
tients seldom possess extraordinary vigour. 

I have still to speak of cases in which there is an excessive or 
vitiated sebaceous secretion, although the prepuce may be of proper 
form. 

Abundant and vitiated secretions of sebaceous matter. — In many 
cases the sebaceous matter is not confined by a too narrow or too 
long prepuce ; it seems rather to be reproduced very rapidly, or its 
properties to be modified by some pathological condition. The 
mucous follicles of the glans and prepuce are much more developed 
and more active in some individuals than in others, and furnish ha- 
bitually a much greater quantity of sebaceous secretion. This parti- 
cular disposition shows itself early, and continues during the whole 
life ; it is a permanent condition, and its effects may show themselves 
at any moment. Extreme cleanliness might perhaps prevent any in- 
convenience being felt; but as the gravity of the consequences that 
may result is not suspected, and as besides, this peculiar predisposi- 
tion cannot be foreseen by parents, there is no motive for causing 
children to practise ablution or friction of the parts — which indeed, 
by drawing their attention, might be dangerous. These cares are 
not practised then at the period of puberty; yet it is then especially 



222 CAUSES OF SPERMATORRHEA. 

that they are requisite in cases where the sebaceous secretion is dis- 
ordered, on account of the orgasm which at that age seizes the whole 
of the genital apparatus. I am thoroughly convinced that this par- 
ticular circumstance is the direct cause of numbers of cases of in- 
voluntary discharges, as well as very frequently of the spontaneous 
abuses of which young lads are the subjects. 

There are other cases in which the secretion is increased or altered 
by a morbid condition, which is ordinarily intermittent, arising almost 
always from a special disposition of the economy, particularly from 
cutaneous diseases, often enough hereditary ones. The constitution 
of such patients is ordinarily weak and delicate; their childhood, 
sickly. The first symptoms of these cutaneous affections which 
generally sooner or later attack the mucous membranes, are mostly 
experienced in the head or face. The children are subject to ring- 
worms, acne, tetters, abscesses in the neck, alternately with attacks 
of ophthalmia, otorrhoea, coryza, angina, &c. At the approach of 
puberty, these weakly constitutions generally improve, and seem 
about to become hardy; but the revolution effected by that important 
crisis has not always the durable and salutary effect on the constitu- 
tion that could be desired. The genital organs become the centre, 
and attract the congestion which formerly acted chiefly towards the 
head; and hence cutaneous eruptions occur in the neighbourhood of 
the anus, in the perineum, on the interior of the thighs, or the 
scrotum, at the base of the penis, and more than all, on the prepuce 
— bringing the most unfortunate consequences. Whatever may be 
the species of these eruptions, however unimportant they may ap- 
pear, it is of the utmost consequence to pay attention to them when 
they attack the prepuce or glans. 1 From them arise frequent ba- 
lanitis, more or less abundant, and acrid sebaceous discharge, ex- 
coriations, herpes, erysipelatous redness of the prepuce and glans, 
frequent attacks of urethritis, often as severe as virulent clap, and 
almost always more difficult of removal, frequently also giving rise 
to serious errors of treatment. This irritation, too, sometimes sud- 
denly attacks parts at a considerable distance from the orifice of the 
excretory canal; hence the sudden appearance of pain in the peri- 
neum, or neck of the bladder ; hence the painful swelling of the vasa 
deferentia and testicles ; hence also the no less sudden disappearance 
of these symptoms, on the unexpected appearance of inflammatory 
disorder on some other part of the body. 

It is easy to conceive that these irritations may provoke abuses or 
temporary excesses, as well as more or less serious occasional semi- 
nal discharges ; but as these are not merely nocturnal pollutions, 
and as diurnal ones are more common, more serious, and very dif- 
ficult of discovery by the patients — their existence is seldom sus- 
pected; so that they do not know how to account for the periodical 



See Chapter V. 



CONGENITAL PRE-DISPOSITION. ZZ6 

derangement experienced in their health precisely at the times when 
they are not troubled with apparent disorder. Their friends under- 
stand still less the frequent and sudden changes of character they 
experience — the alternations of gaiety and hypochondriacism, of ac- 
tivity and torpor. Such patients are, therefore, very often regarded 
as maniacs; their peevish restlessness, and strange paroxysms, are 
attributed to wrong-headedness, to attempts at originality, or to some 
other equally erroneous explanation. 

After a time diurnal pollutions occur almost constantly : and 
now there are only slight remissions in the symptoms; the health 
remains imperfect, and the paroxysms occur more and more fre- 
quently : at last matters grow still worse, and the patient's disorder 
becomes constant. 

Both the patients and their medical attendants are led astray during 
the most severe periods of the disease, by the diminution or entire 
cessation of the nocturnal pollutions; diurnal discharges, whose 
effects are much more serious, take their place; and this is why, 
on the entire cessation of nocturnal pollutions, the disorder becomes 
permanent, and complete impotence is often established. Lessening 
of the nocturnal pollutions is not likely to lead the patients to suspect 
the true cause of their disorder; they imagine themselves the victims 
of a syphilitic affection, founding their opinions on the discharge and 
excoriations that occur in the neighbourhood of the glans and pre- 
puce, or on the attacks of urethritis to which they are subject. I 
have met with many patients who had spent a considerable portion 
of their lives under courses of mercurial treatment, which had been 
repeated over and over again, because intercourse scarcely ever took 
place without producing excoriations: these they fancied were 
chancres, however little cause there might have been to suspect 
syphilitic contagion. In such patients, too, the mucous membrane of 
the urethra becomes altered in structure, so that they are more and 
more exposed to urethral discharges from very slight causes; and 
the repetition of such discharges confirms their belief in a syphilitic 
taint. 

In these cases cauterization is the most powerful means we can 
employ. Still it is necessary, after considerably modifying the con- 
dition of the urethral mucous membrane, not to neglect acting on the 
skin and on the whole economy by means of the sulphuretted baths. 
It is wiser also to perform circumcision, than to trust to the patient's 
cleanliness, in order to guard against the inconveniences arising 
from superabundant secretion of the mucous follicles of the pre- 
puce and glans, and to remove the parts beyond the possibility of 
further irritation. 

I have spoken several times of the influence exercised by excre- 
tory canals on the glands that supply them : on comparing the glans 
penis with other openings to excretory ducts, we see that it alone 
possesses an extensively developed erectile and nervous tissue. It 
is true the nipple presents something similar, and its influence over 



224 CAUSES OF SPERMATORRHEA. 

the lacteal secretion is well known ; but there is a vast difference be- 
tween the vessels and nerves of the nipple and those of the glans 
penis. In the glans every thing seems arranged to increase the ex- 
quisite sensibility of the surface. Is it to be wondered at. then, that 
the functions of the seminal vesicles and testicles are much influ- 
enced by every action on so impressionable a surface? and that the 
accumulation of sebaceous matter provokes importunate erections 
before puberty, and abuses or precocious excesses, in persons who 
would seem to be out of danger of them, on account of the small de- 
velopment of their genital organs? 

The divisions under which I have treated this subject are intended 
to show that the irritating action of the sebaceous matter .may arise 
either from its too long retention, from a local affection, or from a gene- 
ral disposition. In the first case excision of the prepuce is indis- 
pensable, and when there is simply a natural phimosis, this is gene- 
rally sufficient. But when the prepuce is excessively long, after its 
removal, and even after cauterization of the prostatic surface, we 
have still to combat the natural debility of the organs — a debility 
sufficiently evident by the exuberance of the skin in front of the ru- 
dimentary erectile tissues. In cases of superabundant secretion of 
sebaceous matter, of herpes preputialis, or other skin affections, 
having a tendency to fix themselves on the prepuce, it is more pru- 
dent to circumcise the patient than to trust to the most careful clean- 
liness ; there is no comparison between this trifling operation and 
the importance of the involuntary discharges which may return with 
a return of the preputial irritation, even if once relieved by the use 
of sulphuretted waters or other means. Indeed, after having long 
and seriously reflected on the numerous cases that have come under 
my notice, I have arrived at the opinion, that the discontinuance 
of the practice of circumcising children is to be regretted ; the ope- 
ration is, without doubt, unnecessary in many cases, but it can 
never be injurious, and in a great proportion it would be exceedingly 
useful. 

Congenital Debility. 

CASE LYI. 

Relaxed genital organs — Spermatic cords varicose — Few but debilitating 
nocturnal pollutions — Opposite effects of coitus — Unsuspected diurnal 
pollutions — -Constant headache — Disordered senses — Intellectual debility — 
Hallucination — Tonic treatment at the age of twenty-one, followed by re- 
covery. 

In the month of June, 1835, General Mina placed under my care the 
son of one of his friends, who had been treated unsuccessfully for a chronic 
cerebral affection by distiEguished practitioners., both in England and Ger- 
many. 

M. P. Gr ', twenty-one years of age, was well made, of moderate 

height, and robust appearance; his face and embonpoint bespoke health, 



CONGENITAL PRE-DISPOSITION. -22 

although he had complained of headache for several years, and often showed 
serious derangement of his ideas, which were generally wandering and ob- 
tuse. His feeble and husky voice, and timid and embarrassed manners, led 
me to suspect masturbation; I was completely mistaken, however. Whilst 
examining an inguinal hernia, which had come on without apparent cause, I 
noticed evident marks of semen on the patient's shirt; and he told me that 
while travelling the night before he awoke deluged with this glairy matter', 
that he often experienced similar evacuations without dreams, erections or 
any other sensation sufficient to awake him. Further examination convinced 
me that the patient passed semen also at stool, and that his urine constantly 
contained a considerable quantity. I was, therefore, convinced that the sup- 
posed chronic cerebral affection was nothing more than mistaken spermator- 
rhoea — which the result soon confirmed. 

The cause of these discharges was sufficiently obscure. The patient's 
parents were strong'and healthy, and he had ten brothers and sisters all in 
good health; there was no hereditary disease in his family, and his infancy 
had been passed without ailment. At the age of sixteen nocturnal pollutions 
had occasionally appeared, without dreams, and without sensation; the pa- 
tient was completely ignorant of every thing appertaining to sexual inter- 
course, as well as masturbation. He was passionately fond of study. At 
the age of seventeen he had frequent headache, and disordered vision; ob- 
tuseness in his ideas; loss of memory; intellectual employment fatiguing and 
unrepaying; he had several times, too, long fits of unconsciousness without 
apparent cause. At the age of eighteen M. P. Gr was placed in a com- 
mercial school at Paris; two months afterwards he left his studies one eve- 
ning on account of a violent headache ; a vague but imperious feeling, to 
which he yielded, impelled him towards the other sex. The following day 
he was much better; he felt more vigorous both physically and morally. 
But notwithstanding this beneficial effect, the patient yielded only once 
more, although he felt much relieved on that occasion also. 

Soon afterwards M. P. Gr was placed in a commercial house in Lon- 
don, where he worked assiduously for two months, at the end of which 
time he suffered from headaches, giddiness, disordered vision, noise in his 
ears, &c; residence in the country produced slight improvement, which 
was, however, lost on the patient's returning to the same occupation; so 
that after a short time he was unable either to write or to keep his accounts. 
He experienced such frequent giddiness, and so great weakness in his legs 
that he dared not go out alone. At length his intellect became deranged 
to such an extent that he doubted every thing he heard or saw, all that he 
did, and even his own existence. By degrees his digestion also became 
deranged, and his medical attendants sent him to travel in Belgium and 
GJ-ermany. During this long journey he became more and more dis- 
ordered; every thing seemed illusory and fantastic; he fancied himself in 
a painful dream. He imagined too that every one was ridiculing him, and 
conspiring against him; and he especially suspected three Englishmen who 
followed the same route, and who he thought were plotting together against 
him. One of these was especially hateful on account of his ironical man- 
ner; and the patient was a hundred times tempted to precipitate this gen- 
tleman into the Rhine as he passed him on board the steamboat: these 
hallucinations remained on the patient's memory after his recovery, like a 
kind of nightmare. At the close of this journey he was brought. to con- 
sult me. 

15 



226 CAUSES OF SPERMATORRHOEA. 

When I saw him his nocturnal pollutions recurred only at intervals of 
eight or ten days, which did not, however, prevent their debilitating effects; 
these were the more remarkable when contrasted with those of coitus al- 
ready mentioned. The patient too experienced the same state of weakness 
when he had erotic dreams or venereal desires, even a] though no apparent 
discharge took place. 

These phenomena were easily explicable by the presence of diurnal pol- 
lutions; but there was nothing to account for the early development and 
constantly increasing recurrence of these abundant discharges. The exa- 
mination of the inguinal hernia gave some information. I have already 
stated that it came on without appreciable cause; announcing great relaxa- 
tion in the inguinal rings; the opposite side too showed a marked disposition 
to the occurrence of hernia ; the vein3 of both spermatic cords were varicose ; 
the penis of moderate size, was very long and soft, and the scrotum was so 
relaxed that the patient was obliged to wear a suspensory bandage. I passed 
a very large catheter, too, into the bladder, without experiencing the least re- 
sistance, and without the patient's giving the least sign of pain. 

The union of all these circumstances led me to conclude that the sperma- 
torrhoea was exclusively due to atony of the ejaculatory ducts; and conse- 
quently, I daily left a catheter in the urethra for two hours at a time; at the 
same time the patient took iced milk three times a day; and iced wine 
mixed with Spa water at his meals; and used cold lotions frequently, with 
a hard bed, and horse exercise. These means brought about a prompt and 
decisive change; within a fortnight the patient's headache had left him to- 
gether with the aberrations of intellect which had accompanied it; his per- 
ceptions became clear, his ideas precise, his motions prompt and decided; 
the use of mineral waters, especially of alternate hot and cold douches on 
the loins and perineum consolidated his cure. 

I saw M. P. Gr the following year, and also in August, 1838; his 

diurnal pollutions have not reappeared ; nocturnal pollutions happen after 
prolonged continence; they are energetic, and do not injure the health. All 
his functions are perfectly well performed. 

This case is another example of the powerful effects produced on 
the brain by involuntary seminal discharges. In the present case 
the pollutions evidently arose from congenital atony of the genera- 
tive organs. It is likely enough that I should not have discovered 
these debilitating discharges, had I not done so accidentally while 
examining the patient's inguinal hernia. Nothing in the patient's 
conduct could have led me to suspect the presence of pollutions, and 
his constitution, as well as the history of his family, did not point 
out any local weakness. On the contrary, circumstances were pre- 
sent which would lead away from the true cause of his disorder; his 
nocturnal pollutions were very rare, and coitus was on both occa- 
sions followed by remarkable improvement in the health. This may 
be easily explained by bearing in mind what I have already said 
respecting the different effects of different kinds of spermatic dis- 
charges; — the excitement produced by the normal act diminishing 
the relaxation of the tissues and the abundance of the involuntary 
discharges. 



CONGENITAL PR E-DIS PO S ITION. 227 

How was it that this patient did not show more inclination towards 
the other sex, especially after having noticed the beneficial effects 
of his first intercourse ? He attributed this indifference to the pro- 
found melancholy which possessed him from the period of puberty; 
but this sadness disappeared, and his ideas completely changed after 
his cure. The indifference, then, arose from the diurnal pollutions 
of which "he was the victim. 

This patient's hallucinations were of the same nature as those of 
Esquirol's patient, (Case thirty-two,) only that the conviction of a 
general conspiracy against him was more confirmed. If in one of 
his moments of rage he had thrown his supposed enemy into the 
Rhine, would this hallucination have been admitted ? If so, would 
its cause have been even suspected ? 

Varicocele. — I have met with many cases of involuntary seminal 
discharges occurring in patients who were affected with varicocele. 
I have at present before me three consultations and numerous notes 
of such cases ; but they are for the most part incomplete, because I 
am ignorant of the results of the means employed. I will, however, 
briefly relate all that can be gained from them relative to sperma- 
torrhoea. 

One of these patients was addicted to masturbation about the age 
of ten ; he practised it, however, much less frequently than the ma- 
jority of his companions; and corrected himself at the age of fifteen. 
Another committed some slight venereal excesses, but very irregu- 
larly and for a very short time on each occasion. A third suffered 
from simple blennorrhagia, after which swelled testicle came on the 
day after a ball. A distinguished barrister first experienced noctur- 
nal pollutions during the period of his examination ; afterwards he had 
numerous relapses, following the excitement of important causes, and 
was obliged to give up his profession, notwithstanding his talent, be- 
cause the pollutions, becoming diurnal, weakened his memory. It 
is probable that in these cases no bad effects would have been pro- 
duced if the patients had not been pre-disposed to them. Other 
patients affected with varicocele and pollutions pursued courses of 
life, which might be considered exemplary, if compared with the 
lives led by hosts of individuals who never suffer any bad effects 
from such proceedings. I have besides questioned those patients 
who have consulted me for varicocele alone, and I have found that 
the greater number complained of want of power in the organs. Del- 
pech made the same remark; and he attributed this want of power 
to the torpidity of the venous circulation which retarded the sperma- 
tic secretion ; he thought too, that by taking away the varicose veins 
he would be able to restore the functions to their normal condition : 
the unfortunate death of the author of this proposition is sufficient 
to show its fallacy. 1 As far, however, as regards the debility of the 

1 The unfortunate Delpech was assassinated in the middle of the day by a patient 
from Bordeaux, on whom he had previously operated for varicocele. The murderer 
immediately afterwards blew his own brains out. 



228 CAUSES OF SPERMATORRHEA. 

spermatic organs in such persons, I agree -with him perfectly ; in- 
deed, it is a point which I have observed too often to admit of my 
doubting it. I have also remarked that in many of these cases the 
testicles are soft and small, and when the spermatic veins of one 
side only were varicose, I have invariably remarked that the testi- 
cle of that side did not correspond in development to that of the 
other. Pott has related several cases of the same kind. 

If masturbation, venereal excesses, orchitis, &c. favour the deve- 
lopment of varicose veins in the spermatic cords, this can only take 
place in persons who are pre-disposed to that disease by congenital 
weakness of the parts ; for many persons are exposed to the opera- 
tion of all these causes without having varicocele, which disease often 
comes on without appreciable cause. The same thing happens here 
as in varicose veins of the lower extremities ; fatigue of the parts, 
as well as every thing which hinders the free return of blood, un- 
doubtedly contributes to render the veins varicose ; and yet are 
there not many who pass hours together standing, and who wear 
tight garters, but nevertheless do not suffer from varices? whilst 
there are numbers on the other hand who are victims of this in- 
firmity without being particularly exposed to the action of such 
causes. It must, therefore, be admitted in the latter class of cases, 
that there is some primary weakness or congenital disposition in the 
affected veins to become varicose. 

Since, then, we see want of energy in the genital organs so fre- 
quently accompanying varicocele, it is evident that the venous sys- 
tem is not alone in a state of atony or relaxation ; and it is, there- 
fore, of consequence to pay attention to the condition of the veins 
in order to judge of the power of the genital organs as well as of 
the pre-disposing causes of involuntary emissions. Such signs 
point out the remedies to be used in these cases. 

CASE LYII. 

Hypospadias — Impotence — Frequent seminal discharges. 

Morgagni relates with his customary precision an interesting case of im- 
potence, which he attributes to the malformation of the glans, but which 
was evidently due to involuntary discharges : the following are the principal 
circumstances. 

The patient was scarcely thirty; he was by no means strong, and was 
affected with an old ophthalmic disorder. He admitted that although he 
had been married two years, he had never had sexual intercourse; this he 
attributed to the glans penis being curved downwards, and perforated near 
its base, instead of at its point. The inferior wall of the urethra was in 
fact wanting in the neighbourhood of the glans, and a little behind it; the 
prepuce was divided in the same manner and resembled that of the clitoris. 
The penis was of its natural development, the testicles were large, but the 
scrotum appeared relaxed. At the period of puberty, the erections had 
been complete, the glans being folly injected as well as the rest of the penis; 
an uncomfortable sensation even arose in the part where the urethra was 



CONGENITAL P RE-DI S P S ITI N . 229 

wanting; but this sensation diminished by degrees in proportion as the glans 
entered" less into erection. At the time of the patient's marriage the tume- 
faction of the glans took place very rarely; at last' it ceased entirely, "the 
glans remaining flaccid and insensible from the time when, in useless efforts 
at intercourse, the patient discharged large quantities of semen, which escaped 
very promptly." 

Morgagni is inclined to think that the absence of the urethra 
underneath the glans was the cause of its not becoming erect in this 
case; the rest of the penis was capable of erection, but the glans 
being a portion of the corpus spongiosum, and receiving its blood 
from the bulb, was incapable of becoming so. This explanation, 
although plausible and founded on the distribution of the arteries 
of the penis, rests on an incorrect hypothesis ; for in cases of this 
nature the parietes of the urethra are not wanting, there is only de- 
fective union in the median line, which by no means interferes with 
the presence of the corpus spongiosum, nor with its receiving its 
proper arteries. Besides, the malformation in Morgagni's case was 
equally present at the age of puberty, yet the patient experienced 
erections at that time into which the glans entered, so much so, in- 
deed, as to cause a painful sense of dragging in the situation of the 
urethra. The patient's impotence was, therefore, due to some other 
cause, and this cause was evidently the same that acted in case fifty- 
five. The impotence, therefore, arose from habitual and unperceived 
seminal discharges, favoured by the congenital debility of the organs. 
Morgagni's last sentence is sufficient to prove this. When did the 
glans entirely cease to become erect? "From the time when in useless 
efforts at sexual intercourse, the patient discharged large quantities 
of semen, which escaped very promptly." These repeated and 
abundant seminal discharges then rendered the erections less and 
less energetic, and at last thoroughly imperfect. 

The rapidity with which ejaculation took place is observed in all 
cases of this nature; and this hasty emission, whether it arise from 
irritation or debility, or both, which opposes intromission as much as 
the insufficiency of the erections, is always accompanied by diurnal 
pollutions : to these, therefore, the impotence is due, (although very 
often they are unsuspected,) and they are invariably exasperated by 
unavailing efforts at coitus, which increase the irritation and debility 
of the parts. On the other hand, too, such appreciable discharges 
joined to those which are unsuspected, sufficiently explain why the 
erections become daily less energetic, and the formation of the semen 
less perfect. 

The remarkable coincidence of hypospadias with debility of the 
genital apparatus has induced me to quote the above case. Hypos- 
padias is a rare malformation, and has never been studied in reference 
to its connexion with weakness of the organs. It is well known that 
Louis XVI. had hypospadias, and the Memoirs of Madame de Cam- 
pan leave no doubt that his marriage was not consummated for 
several years. I have met with one case of hypospadias in the 



230 CAUSES OF SPERMATORRHEA. 

hospital St. Eloi; it was accompanied with nocturnal and diurnal 
pollutions, but I only had an opportunity of observing the patient 
for two or three days, and I cannot say decidedly that these pollu- 
tions arose solely from a natural weakness of the organs. 



CASE LVIII. 

Atrophy of one testicle at the age of eight — Nocturnal and aftericards di- 
urnal pollutions — Frequent desire of micturition, <$cc. 

I have at present a student, set. twenty-seven, under my care, who, from 
the period of puberty, has been troubled, with nocturnal at first, and after- 
wards with diurnal pollutions. All his functions are deranged, and he is now 
incapable of any intellectual employment. He has never had sexual inter- 
course, and he has not been addicted to masturbation. When about eight or 
nine years of age he suffered from inflammation of the left testicle without 
evident cause. After having continued very large for some time the organ 
atrophied by degrees, so that it is reduced to the size of a horse bean, the 
spermatic cord being also very thin. The urethra is extremely sensitive, 
especially in the neighbourhood of the prostate, and the patient makes water 
very frequently — this symptom dating from his childhood. 

There existed without doubt in this unfortunate individual a con- 
genital disposition to phlogosis of the genito-urinary organs; this 
showed itself at the age of eight, by spontaneous inflammation of the 
left testicle ; from that time irritation continued in the neighbourhood 
of the bladder, and extended its influence to the right testicle. This 
accounts for the occurrence of nocturnal pollutions at the age of 
puberty. Spontaneous inflammation of the testicles in childhood is 
then a sign of a morbid condition of the genital organs, and the de- 
struction of one of the testicles does not remove the patient from 
the danger of involuntary seminal discharges, which may even be 
sufficiently abundant to injure the health. 

Natural Relaxation of the Ejaculatory Duets. — There are a 
certain number of cases of involuntary seminal discharges, which it 
is impossible to attribute to any satisfactory cause; which are not 
accompanied by any sign of irritation ; and to explain which we 
are obliged to admit a natural disposition, debility or congenital re- 
laxation of the spermatic organs, and especially of the ejaculatory 
ducts. This condition sometimes coincides with more or less charac- 
teristic external signs, but in other cases it is only shown by its 
effects. The following remarkable case will explain what I have to 
say on this obscure but important subject. 



CONGENITAL PRE-DISPOSITION. 231 



CASE LIX. 

Lymphatic temperament — Incontinence of urine — Neither masturhation nor 
sexual intercourse — More and more frequent nocturnal pollutions — Re- 
laxation of the sphincters of the anus and neck of the bladder — Treat- 
ment unsuccessful. 

M. M of very marked lymphatic temperament was subject to in- 
continence of urine up to the age of twelve or thirteen. His religious 
enthusiasm induced him to embrace the ecclesiastic profession. He had 
never practised masturbation nor had sexual intercourse. Puberty did not 
take place until the age of eighteen, but was accompanied with nocturnal 
pollutions — rare at first — then more frequent; and at length occurring daily 
and quite passively. All his functions were successively deranged, and at 
the age of twenty-three, five years from the commencement of his disorder, 
M. M consulted me in the following condition. 

Skin white, cold, and clammy; limbs rounded; hair white; no beard; 
pelvis very large ; hips projecting; flesh soft; genital organs pretty well de- 
veloped, but very flaccid; scrotum much relaxed; hair very scanty; blindness 
nearly total; enormous dilatation of the pupils; considerable decrease of in- 
tellect and memory; extreme weakness of the limbs; progression almost 
impossible without the support of a stick; digestion difficult; involuntary 
discharge of fasces several times a day; micturition frequent during the 
day; incontinence of urine at night; nocturnal pollutions repeated se- 
veral times a night without erection or sensation; semen very fluid ; urine 
often muddy. I passed an immense catheter into the bladder without ex- 
periencing the least resistance, or giving the patient the slightest pain; the 
anus was almost wide open, permitting the introduction of three fingers into 
the rectum without the least difficulty, and without exciting any action of 
the sphincters. 

I prescribed aromatic baths, stimulating frictions and applications; ice 
internally and externally, Spa water, quinine, &c; and I performed two 
cauterizations of the urethra, all without the least success : after four months' 
treatment I lost sight of this unfortunate patient, leaving him in just the 
same state as when he first consulted me. 

All circumstances combined in this case to convince me that the 
patient spoke truth when he asserted that he was ignorant of mastur- 
bation and had never had sexual intercourse. The incontinence of 
urine and of faeces; the form of the pelvis; the flaccidity of the genital 
organs ; the general state of the economy; all seemed to show that 
the ejaculatory ducts shared the relaxation of the sphincters of the 
anus and bladder, and that this original atony was the sole cause of 
the nocturnal and diurnal pollutions. This case is the most remark- 
able one of the kind that I have ever met with, on account of the 
combination of circumstances that accompanied the relaxation of the 
ejaculatory ducts, and from the absence of every complication that 
could have excited involuntary seminal discharges ; it enables us to 
understand cases in which there are similar but less marked predis- 



232 CAUSES OF SPERMATORRHOEA. 

positions, and which are accompanied by less evident or even nearly 
inappreciable signs. 

CASE XL. 

Sickly childhood — Extraordinary nocturnal pollutions at sixteen — Some 
time after, pollutions during defecation — Ejaculation impossible — Sloio 
discharge of semen after the subsidence of erection — Urethral canal very 
slightly sensitive — Prostatic surface hard and cartilaginous. 

In the year 1825 I was consulted by a medical student, set, twenty-one, 
of small stature, and spare habit, in consequence of deafness, which had 
made considerable progress during two years. After injecting the Eusta- 
chian tube a few times; applying a seton, &c, the beneficial effects of which 
were very trifling, the patient spoke to me about nocturnal and diurnal 
pollutions which were accompanied by extraordinary circumstances. The 
following are the chief facts of the case. 

The patient's health was weak until the age of sixteen, when puberty 
occurred, and he suffered from frequent erections and nocturnal pollutions. 
These discharges continued from that time; they were often excited by 
lascivious dreams, but were not always preceded by erections; when erec- 
tion occurred it was not during its continuance that the discharge of semen 
took place, but only after the swelling of the penis had passed off, the 
matter discharged dribbling over the neighbouring parts instead of being 
forcibly thrown off as in true ejaculation. This matter resembled white 
of egg, and stained the linen in the same manner; it wa3 often so abun- 
dant that the patient was compelled to change his shirt. The evacuations 
were followed by debility, languor, and headache. Whatever quantity of 
semen was passed he never experienced the slightest voluptuous sensation, 
so that at first he thought himself affected with incontinence of urine, and 
when these abundant discharges took place, not being able to prevent them, 
he rose suddenly to micturate. Often while at stool a similar discharge 
took place in greater or less quantity, according to the degree of constipa- 
tion. 

Sexual intercourse had been very rare, and always accompanied with 
similar circumstances; the erections were energetic and long continued; 
indeed, they lasted an indefinite time, for fatigue alone put an end to the 
act : seminal discharge never under any circumstances took place until the 
cessation of the erection. The same thing occurred during a few attempts 
at masturbation, which the patient practised from curiosity, for he never 
experienced sufficient pleasure either in these manoeuvres or in coitus, to 
practise them from inclination ; he had an ardent desire to get rid of his 
nocturnal pollutions, which he believed arose from defective contractility 
in the seminal vesicles. 

This patient was very thin and remarkably pale; his digestion was much 
disordered; his memory treacherous; his intellect weakened; and the least 
application to study excited obstinate and almost constant headache. He 
experienced noise in his ears; and this deafness was very probably due to 
the same cause, although he imagined himself the subject of some local 
affection. 

I did not observe any thing particular in the patient's form nor in the size 
nor consistence of the external organs of generation, but on passing a 



CONGENITAL PRE- DISPO SITI N. 233 

large catheter into the canal, I remarked that it possessed very little sensi- 
bility; and especially in the prostatic region, where the instrument was 
arrested. On taking a smaller one I succeeded in reaching the bladder; 
and in passing the prostate, the instrument seemed to rub on a hard carti- 
laginous surface, which, however, was quite smooth and regular. The 
patient remained quite passive during this examination, which lasted a long 
time. The prostate examined through the rectum did not seem large or 
less regular than natural. Its firmness presented nothing remarkable. 
These examinations, repeated at the intervals of several days, always gave 
similar results. 

I performed cauterization of the prostatic portion of the urethra in the 
hope of modifying its abnormal condition, but no benefit was obtained. 
Dilatation by means of gum elastic catheters was not of greater service. 

This is the only case of the kind of which I am aware ; it presents 
characters quite different from those which generally accompany 
nocturnal and diurnal pollutions ; but it does not the less belong to 
the class of such cases caused by original disposition in the spermatic 
organs. The patient's statements bore the semblance of truth. He 
suffered from pollutions many years before attempting either coitus or 
masturbation ; indeed, it was only in the hope of relieving his disorder 
that he committed these acts; for he was not enticed to them by any 
feeling of pleasure. His remarkable seminal discharges seem to have 
arisen from the induration and loss of sensibility of the surface of the 
prostate and neighbouring parts, and this condition seems to have 
been congenital. 

Symptoms of Debility of the Genital Organs. — Before proceeding 
further, it may be as well to consider for a moment the characteristics 
we have already noticed, as showing debility of the genital organs. 

We have seen that excessive development of the prepuce arises 
from smallness of the penis, and that in the same individual the 
scrotum is often much folded and retracted towards the pubes, be- 
cause the testicles are very small. Such an elementary condition of 
the erectile tissues and secreting organs necessarily augurs little 
energy in these fundamental parts of the genital apparatus, and 
must prove an unfavourable prognostic as regards the condition of 
the ejaculatory ducts, seminal vesicles, and other parts removed from 
external examination. But these characters are not always equally 
marked, and do not always stand alone. 

Hypospadias arises from defective union of the opposite parietes of 
the urethra ; and whatever may have been the cause of this arrested 
development, it indicates debility of the parts, because their forma- 
tion has not been completed. The parts have wanted energy or vital 
force from the beginning. Is it likely that this condition will be 
altered later in life? All I have seen of these cases, leads me to 
a negative conclusion. Cases of epispadias too, consisting of defec- 
tive union of the corpora cavernosa, and, still more serious, eversion 
of the bladder arising from a similar cause, support this opinion; 



234' CAUSES OP SPERMATORRHOEA. 

such individuals are even more feeble in respect of their genital 
functions, than those afflicted with hypospadias. 

The following circumstance, too, may be referred to the same 
cause, although it is less evident. All surgeons who are frequently 
in the habit of passing instruments into the urethra, are aware that 
great differences exist with respect to the size of the meatus. In 
some cases it is exceedingly small, and placed at the summit of the 
glans, in others, again, it is large, gaping and extends from the apex to 
the corona glandis, or even lower. It is evident, that this increased 
size of the meatus arises from the same cause as hypospadias, that 
is to say, from defective union of the two walls of the urethra. In 
some cases, it seems a commencing hypospadias, the opening descend- 
ing lower than the glans. Now I have met with few cases of in- 
voluntary seminal discharges where the urinary meatus was very 
contracted, and in all cases of this kind that I have seen, the disorder 
had been produced by repeated attacks of blennorrhagia, serious and 
long continued abuses, or great sexual excesses, thus showing con- 
siderable activity of the genital functions ; whilst, on the other hand, 
I have met with numerous involuntary discharges in those whose 
meatus was larger, and such discharges have been produced by com- 
paratively slight causes, and were much more difficult of relief. 

My practice of examining all such patients with a large catheter, 
in order to ascertain the degree of sensibility of the urethral mucous 
membrane, led me to make this observation long since, and I have 
since found it remarkably constant. Generally, in cases of large 
orifice, the remainder of the urethra as well as the neck of the blad- 
der is also very large, which might leave one to suppose that the 
ejaculatory ducts may partake of the same condition. However this 
may be, I believe I may mention extended orifice of the urethra, as 
a sign of congenital debility of the organs, and consequently of pre- 
disposition to involuntary discharges. 

The firmness of the erectile tissues, also, differs much in different 
individuals, independently of their size and form. "Whenever I have 
observed the penis resting on the scrotum, the corpora cavernosa 
empty, soft, flaccid, and without resistance or elasticity on pressure, 
I have remarked that the organs possessed little energy, and that the 
powers of resistance to causes capable of inducing involuntary dis- 
charges was very slight, whilst these were always difficult of cure. 

In cases, too, where the glans presents a remarkable development 
in proportion to the penis, the latter being long in the corpora caver- 
nosa, whilst the former is swollen, overshadows the corpora cavernosa, 
and is always uncovered, or at all events, badly covered by the pre- 
puce ; the parts want energy. The erections are often incomplete in 
such cases, especially towards the base of the penis. 

As regards the testicles, their smallness is not the only circumstance 
worthy of consideration. Many of my patients have been afflicted 
with inguinal hernia, frequently congenital. 



C ONGENITAL PR E-DISPO SIT 10 N . 235 

Congenital hernia must be attributed to one of the following causes : 
either the inguinal canal has wanted contractile power, the portion 
of peritoneum accompanying the testicle has been distended with 
serum, or the testicle has descended late into the scrotum. Under 
all these circumstances there is evidently radical debility of the parts. 
It may, indeed, diminish considerably as age advances, but we can 
never expect to find the parts remarkable for their energy. Since I 
have directed my attention to this subject, I have constantly noticed, 
that patients afflicted with congenital hernia presented much smaller 
testicles than those of healthy persons of corresponding age. The 
following fact, too, is very decisive. When hernia is present on one 
side only, the corresponding testicle is always smaller than the op- 
posite one, and frequently this difference extends to half the size of 
the organs. For a long time I fancied this small size of the testicle 
arose from compression of the parts by the hernial sac, but I have 
met with the same circumstance in persons who early wore a truss. 
I then thought that compression of the cord by the pad of the truss, 
might give rise to this defect, but I have not noticed corresponding 
conditions in those who have worn a truss for accidental hernia. The 
descent of the testicle into the scrotum often does not take place until 
long after birth, and in one of the cases I have related, it Was not 
complete until the age of twenty-eight, (case fifty-four.) In all the 
cases of this kind that I have had opportunities of observing, the 
organ has been far from possessing its normal size and form ; and 
still further, in cases where I have had an opportunity of examining, 
after death, the bodies of those whose testicles had not descended, I 
have invariably found the body of the gland small, soft, and elongated, 
and the epididymis deformed and unfolded. I have frequently, too, 
ascertained the exactitude of the opinions of Cloquet on the causes 
that oppose the descent of the testicle ; this distinguished observer 
has pointed out that the testicles are always detained either by some 
malformation or adhesion, and such alterations must necessarily in- 
fluence the functions of the organ. 

To resume, then : congenital hernia, slow descent of the testicles 
into the scrotum, or their final retention in the abdomen, must be 
attributed to debility of the parts, to adhesions, or to alterations in 
their structure, which must more or less injure their functions. 

The form of the testicle is also of considerable importance. The 
body ought to be ovoid, regular, and smooth; the least inequality 
observed on its surface denotes some internal organic alteration. 
The size of the epididymis should be proportioned to that of the 
gland itself; any swelling of this part shows that inflammation has 
taken place, and has not been entirely removed. Such inflammation 
may have left marks of its presence in other parts through which 
the semen passes, and consequently, in the seminal vesicles, and 
even after it has been completely removed, is very likely to return 
in the altered tissues. It often happens, that neither children nor 
their parents are able to assign any cause for the occurrence of these 



236 CAUSES OF SPERMATORRHOEA. 

inflammations, either because they take place during early childhood, 
or because they come on without any appreciable injury. I have met 
with more than one patient who fancied that he had three testicles, 
and this delusion has generally arisen from the increased develop- 
ment of the epididymis forming a kind of supplementary swelling 
attached to the testicle. Whenever I have found this swelling con- 
siderable, the true testicle has been smaller than natural, and in a 
few cases it was completely atrophied. The investigations I have 
made in such cases have convinced me that the organ did not act, 
or acted badly. The patients are not, however, removed from the 
dangers of involuntary discharges by this circumstance, because the 
two organs are not equally affected. I have related a case, in which 
one of the organs was completely atrophied from infancy, notwith- 
standing which, obstinate nocturnal pollutions occurred at puberty: 
these were only attributable to active irritation of the other organ. 

Every alteration then in the form of the testicles, must be attri- 
buted to some old standing affection, and announces some internal 
lesion, which necessarily injures the functions of the part, and warns 
us of the possible occurrence, at some time or other, of other affec- 
tions of the same organs. However slight it may be, this alteration 
in the* form of the testicles merits serious consideration in attempt- 
ing to appreciate the amount of the virile powers, and the disposi- 
tion to other diseases of the spermatic organs. 

I may make just the same remark concerning the vasa deferentia. 
When they are so thin that difficulty occurs in distinguishing them 
from the other structures of the spermatic cord, it is a sign of de- 
bility; but this sign is never met with alone; the testicles are always 
small, sometimes even rudimentary; all the secreting apparatus 
seems to remain in the same condition as before puberty. When, on 
the other hand, the vasa deferentia are swollen, knotty, or enlarged 
towards the epididymis, it is evident that they have been previously 
the seat of some inflammation. 

Softness and flaccidity of the testicles also show little energy in 
the gland, whatever may be its size. I have met with this symptom 
in many patients remarkable for their continence, and the severity of 
whose voluntary discharges bore no relation to the slight accidental 
causes that excited them. On the other hand, this flaccidity of the 
testicle is usually accompanied by a similar condition of the corpora 
cavernosa, which justifies one in presuming that the portions of the 
genital apparatus which are removed from external examination, 
partake of a like disposition. 

I have already stated, that varicocele must be regarded as a sign 
of debility of the genital organs. This debility of the venous system 
of the testicle justifies us in supposing a want of energy in the re- 
mainder of the secretory apparatus ; besides which, the stoppage of 
the circulation through the veins of the cord must injure the capil- 
lary circulation in the testicles, and consequently, retard the secretion 
of semen. I have noticed this in cases of simple engorgement of 



CONGENITAL PRE-D ISP S IT ION. 237 

the veins of the cord, especially when coincident with considerable 
elongation of the organ. 

Encysted hydrocele developed in the midst of these vessels pre- 
sents the same indication for the same reasons. 

Again, all the parts of which I have spoken may possess their ordi- 
nary volume and natural form, hut yet may present a decided flac- 
cidity announcing serious debility. This relaxation especially, is 
easily noticed in the scrotum. Not only does this organ extend to 
a great length, but is soft, smooth and without hair or folds; its 
surface is moist; no motion occurs in it from the contraction of 
the dartos or crema^ter muscle, and its cellular tissue is often infil- 
trated with serum. The most remarkable case of this kind that I 
have met with, is that related at page 231, case 59, in which no 
sexual desire was ever manifested, but the subject of which, at the 
age of puberty, became subject to pollutions which nothing relieved. 

Lastly, all my patients whose virile powers were originally weak, 
had very sharp intonation of voice, sometimes quite falsetto. Their 
hairy system too, was little developed. One patient, at the age of 
seventeen, had not a single hair on his chin or his genital organs. 
These characters resemble those found in eunuchs, with this diffe- 
rence, that the health of eunuchs does not become disordered. 

Symptoms affecting the Urinary Organs during Childhood. — The 
spermatic apparatus does not attain its full development until the 
age of puberty, but the urinary organs perform their functions from 
the period of birth. The connexion that exists between the two sys- 
tems is so intimate, that the observations drawn from the one first 
in action foreshadow the affections to which the other may become 
liable. 

Incontinence of Urine. — It must have been noticed, that in several 
of the cases in which involuntary discharges were manifested spon- 
taneously or from very slight causes, the patient had been subject 
to incontinence of urine from infancy. I have met with numerous 
cases in which this was the case, and they were all remarkable for 
the facility with which involuntary discharges occurred. I shall, 
therefore, briefly review such circumstances in these cases, as may 
throw any light on the connexion existing between congenital affec- 
tions of the urinary passages and involuntary seminal discharges. 

In proportion as the child's intellect becomes awakened, he un- 
derstands the care lavished on keeping him clean, and accustoms 
himself to assist, until at length he arrives at an age when he has 
acquired sufficient empire over his habits to avoid soiling his bed 
or his clothes, at least except in cases of accident. This period 
varies according to the child's education and mental progress. But 
when the cerebral functions are thoroughly developed, and the most 
determined will, and best sustained attention, are not sufficient to 
prevent the untimely discharge of the urine, there is a more or less 
disgusting infirmity. Punishment has no effect; it is from the medi- 
cal man that aid must be sought. 



238 CAUSES OF SPERMATORRACEA. 






This condition of the urinary organs may present infinite shades 
of variety ; the worst is that in which the child is unable to hold his 
urine, even when awake, so that it escapes in an almost continuous 
manner without his knowledge. This degree of incontinence is sel- 
dom observed, except in idiots, whom we must leave out of the 
question, because of their want of intelligence, leaving them in pre- 
cisely the same condition as the infant in its cradle. Next come 
those cases in which the neck of the bladder does not contract 
strongly enough to prevent, for any length of time, the passage of 
urine, even during walking ; so that when the desire cannot be im- 
mediately satisfied, the want of power in the neck of the bladder al- 
locs a portion of the urine to escape, notwithstanding all the efforts 
of the will. It is evident, that in such patients the urine will escape 
much more readily during the night. When it is only during sleep 
that the escape of urine takes place, the infirmity is grievous enough, 
but even then it may present many shades of severity. In some 
cases, the involuntary emission takes place every night ; in others it 
only occurs when the bladder was not carefully emptied before the 
patient went to sleep, or because a large quantity of fluid had been 
drunk during the evening. And lastly, in a few cases, the discharge 
is nearly voluntary, because it follows some dream excited by the 
distention of the bladder ; in these cases it may be considered rather 
as an accident than as a habit. 

Great difference also exists in the duration of this infirmity: in 
the worst cases it continues after puberty — more or less changed, 
however, according to the influence which this important period of 
life exercises on the constitution. In all my patients who had pol- 
lutions after incontinence of urine, I have remarked that the latter 
infirmity continued at least until the age of seven or eight years; in 
many it continued until the approach of puberty, and such patients 
always retained a frequent desire of emptying the bladder, as well 
as considerable difficulty in resisting that desire, especially when 
acting energetically. 

It is evident, from what I have just stated, that incontinence of 
urine diminishes in proportion as the constitution gains strength, and 
that it generally ceases entirely at the age of puberty, or is, at least, 
always considerably modified; and this is enough to show, that the 
infirmity arises from original debility of the urinary passages. The 
treatment too that is most successful, supports this opinion. All 
useful remedies are derived from the tonics and astringents. I have 
invariably found benefit from aromatic baths in such cases, and I 
have now treated a vast number of them. I consider, therefore, 
that incontinence of urine arises from atony or debility of the neck 
of the bladder. 

It is not without reason, then, that the approach of puberty is con- 
sidered likely to effect a cure in such cases : such a result is explained 
by the urinary passages sharing the excitement set up at this period 
in the genital organs; and this intimate connexion is sufficient to 



CONGENITAL PRE-DISPOSITIOI>. 239 

point out that incontinence of urine in childhood is a bad symptom, 
when considered in connexion with the powers of the genital organs, 
in after life. The cases I have seen leave no doubt on my mind 
on this subject; and I should add, that aromatic baths have been 
very useful in cases complicated in this manner. After aromatic 
baths I may mention cold bathing, ferruginous preparations, qui- 
nine, columba, &c, which are also useful in relieving the inconti- 
nence of urine itself. Sulphuretted baths have also frequently pro- 
duced good effects. 

Retention of Urine. — This accident is very rare in childhood. I 
have, however, notes of two cases of obstinate involuntary discharges 
in which it occurred. In the first case, frequent retention took 
place about the age of two years, and was occasionally so serious 
that the aid of the catheter was required for its relief. Up to the 
age of sixteen, too, the patient was never able to pass urine with- 
out making ineffectual efforts for a quarter of an hour or more ; and 
even when he consulted me he was obliged to wait five or six 
minutes before the discharge took place. He was also subject to 
hemorrhoids from infancy — which is very rare. The susceptibility 
of the genital organs was so great in this patient, that pollutions 
were produced by viewing lithographed plates showing the anatomi- 
cal details of pregnancy. 

The other patient was a young man, set. twenty-one, who con- 
sulted me for pain in his chest and stuttering, which had come on 
after puberty. Eetention of urine occurred occasionally during his 
childhood up to so advanced a period that he was able to furnish 
an exact detail. At the age of fifteen, after having travelled some 
time with a female — causing him considerable excitement — he passed 
a large quantity of semen with the last drops of his urine; after- 
wards the same circumstance frequently occurred without any previ- 
ous excitement. He noticed also that he passed semen during 
efforts at stool. He occasionally practised masturbation, but at very 
distant intervals, and he never passed on such occasions more than 
two or three drops of semen. He had opportunities of sexual inter- 
course six times in four years, and on each occasion found himself 
completely impotent. This patient deceived himself curiously as to 
the cause of his want of power: once he imagined that it arose 
from the disgust inspired by a prostitute ; once from the respect he 
felt towards a mistress; on another occasion he eat too much before 
going to his rendezvous; at other times he had drunk too much 
punch, eaten too many strawberries, &c. I mention these subter- 
fuges, because patients who are in this unfortunate position take 
vast trouble to deceive themselves. 

The impotence in this case arose from diurnal pollutions which 
had evidently long preceded the rare attempts at masturbation which 
the patient committed. He came to consult me for an affection of 
the chest, and stated that he should return shortly. Two years after- 
wards, however, I learnt from his elder brother who consulted me 



240 CAUSES OF SPERMATORRHEA. 

for a similar affection, that lie became so ill as to be unable to under- 
take the journey, and that he died at the expiration of three months. 
His brother strikingly resembled this patient, not only physically but 
morally; he was also affected with stuttering, There was, there- 
fore, in these two brothers, a congenital predisposition to involun- 
tary seminal discharges, shown in the younger by very early reten- 
tion of urine. The younger one, too, died, while the other recovered 
easily enough. 

The following consultation has recently been sent me. The pa- 
tient's grandfather died of a calculous affection; his father is of very 
nervous temperament, and. subject to retention of urine arising from 
affection of the prostate; the patient himself, born during the distur- 
bances in La Vendee, has always been delicate and very irritable. 
He has never been able to empty his bladder completely, what- 
ever efforts he may make for that purpose, and the first jet of urine 
is always long in appearing. He practised masturbation very rarely 
when between fourteen and fifteen years of age. He is, however, 
subject to debilitating nocturnal pollutions, which have injured his 
health. Warm baths, abstinence from wine, and a non-stimulating 
diet, together with refreshing beverages, were the means which pro- 
duced most benefit. 

In all cases of early retention of urine, a decided disposition to irri- 
tation of the prostate is to be suspected, instead of debility and relaxa- 
tion of the parts such as are found in persons who have been subject 
to incontinence when children. 

To resume, then : incontinence of urine is a symptom the more seri- 
ous in respect to the genital functions in proportion as it is more com- 
plete and prolonged, and the pollutions which follow it so easily are 
to be attributed, in a great majority of cases, to congenital relaxation, 
or debility. Such pollutions are always very obstinate. 

Retention of urine announces just as surely a disposition to phlo- 
gosis in the prostatic portion of the urethra; and this is more marked 
in proportion as the retention occurs early in childhood, a period at 
which the organs are not exposed to the irritations that act on them 
after puberty. 



Hereditary Transmission. 

CASE LXI. 

JBlennorrhagia at the age of twenty-one- — Pains in the testicles — Pollutions 
during four years — Serious gastric and cerebral symptoms occurring in 
paroxysms — Hereditary predisposition — Iced milk — Cauterization — Acu- 
puncture — Sulphuretted baths — Recovery. 

In November, 1835, Dr. Guillemot requested my opinion on a patient of 
his, whom he thought affected with chronic cerebral affection. The follow- 
ing are the chief facts. 



CONGENITAL PR E-D IS PO S IT ION . 241 

M. M , of lymphatico-nervous temperament, and excellent disposition, 

whose father had been weak and unhealthy, passed his childhood without 
suffering from any serious disease, but was always subject to diarrhoea ac- 
companied by very painful tenesmus, which generally yielded to slight me- 
dical treatment, but was reproduced from very slight causes. He led a se- 
dentary studious life, and had never committed excesses of any kind. 

In 1827, at the age of twenty-one, he contracted simple blennorrhagia, 
which yielded quickly to the use of demulcents; soon after, he experienced 
a vague dull pain in the testicles, which troubled him much on account of 
its seat and its constancy, although his medical attendants did not consider 
it of consequence. He had also repeated nocturnal pollutions, followed by 
fatigue and general uneasiness, especially when they occurred very frequently. 
His erections, too, were sometimes painful. During four years, he suffered 
constantly from indisposition; he had frequent attacks of indigestion, repeated 
headach, and sudden attacks of giddiness, although these were slight and 
passing. His memory and aptitude for intellectual employment were dimi- 
nished. In 1831, he had strange noises in his right ear, accompanied with 
buzzing and momentary deafness, which went off and returned without evi- 
dent cause. The attacks of cerebral congestion became more severe, but 
were still of short duration. 

In March, 1832, the first serious attack occurred; it was ushered in by an 
abundant discharge of urine with notable digestive disorder, and was after- 
wards marked by violent spasms and constant giddiness, which did not allow 
the least motion of the head without loss of consciousness. Venesection and 
leeches were had recourse to, with marked increase of the agitation and other 
symptoms. Blisters and a seton in the nucha were followed by momentary 
relief; but similar attacks soon recurred. 

In 1833, the patient experienced much dread of the cholera; he had symp- 
toms of hypochondriasis, which were attributed to fear, and completely lost 
his hearing on the right side. In November, he was bled in the foot, and 
injections of vapour and fluid into the ears were practised without benefit. 
Russian and Egyptian baths were used, and immediately afterwards, several 
violent attacks occurred, exactly similar to those before suffered. A severe 
regimen was now ordered, together with a large issue in the nucha; no be- 
nefit resulted. A venereal taint was now suspected by Recamier, and mer- 
curial baths ordered without any effects worthy of notice. The attacks were 
now supposed to be periodical, and sulphate of quinine was ordered; but on 
the third day of this new treatment, a still more serious attack occurred, and 
Marjolin and Baudelocque were consulted. Fresh issues were made in the 
nucha, and mercurial pills and decoction of sarsaparilla were ordered. During 
three months little change occurred. There was violent pain in the right 
shoulder, with an eruption in the neck. 

In the spring of 1834, a slight improvement took place, which lasted two 
months, after which, the same attacks returned with increased frequency and 
severity. Valerian and belladonna were now prescribed without benefit. In 
the spring of 1835, another remission in the symptoms took place; but at the 
end of the summer, the same accidents recommenced. 

When I saw the patient, his last attack had continued upwards of a 
month almost without remission; his emaciation and pallidity were striking; 
he lay on his back quite motionless, not daring to lift his head from the 
pillow, or even to turn from right to left; on the least attempt at motion all 
things around him seemed to turn at the same time that he turned with 
16 



242 CAUSES OF SPERMATORRHEA. 

them, and the room appeared to sink with him ; his cephalalgia was intense 
and constant, and especially felt in the region of the right ear; the corre- 
sponding temporal region was more sensitive than the other, and the mouth 
was drawn to the opposite side when his lips were in motion. There was 
constant stiffness of the neck; he was unable to bear the least light or noise, and 
even a slight motion of the air increased his irritability, and caused serious 
symptoms. His pulse was feeble and remarkably slow; his urine passed 
abundantly, was muddy, and deposited much sediment, containing phosphate 
of lime, with a thin mucus uniformly mixed, and a denser deposit which oc- 
cupied the lower layer. 

It seemed evident that this deposit contained semen in abundance, 
although I was unable to satisfy myself completely of the presence of sper- 
matorrhoea, on account of the quantity of urinary salts present. The 
patient asserted, that several of his most severe attacks had come on imme- 
diately after abundant nocturnal pollutions, and that he always felt worse 
the day after they had taken place. Still the deafness on the right side, the 
pain in the neighbourhood of the right ear, and the deviation of the mouth 
to the opposite side, seemed to indicate a chronic affection of the right in- 
ternal ear, which probably had extended to the membranes of the brain in 
the neighbourhood. On the other hand, both the patient and Dr. Guillemot 
had noticed that every attack had been preceded by an abundant secretion 
of clear colourless urine, with marked disorder in the digestive organs. I 
still feared that I might be misled, by having my mind preoccupied with the 
subject of spermatorrhoea, and I therefore, at this time, declined to advise 
cauterization. 

Iced milk, however, I ordered, and it re-established the functions of the 
stomach in a short time, and increased the patient's appetite, which he was 
obliged to satisfy frequently under the penalty of again suffering from cere- 
bral symptoms. Camphor was insupportable on account of its influence on 
the head, and opiate enemata produced constipation. Syrup of nymphea, 
however, had a better effect. After its use the nocturnal pollutions 
became more rare, and the urine, after several variations, at length con- 
tinued perfectly transparent, (excepting on the days following nocturnal 
pollutions,) during forty days. By degrees, the severe attacks became less 
frequent, and the patient at last passed two months without experiencing 
any: his deafness was less complete; his attacks of giddiness ceased, and 
at length he had resumed his ordinary diet, and thought himself cured, 
when in the middle of March, 1836, his nocturnal pollutions again became 
more frequent; the urine constantly contained an abundant spermatic de- 
posit; his digestion grew difficult, and with the symptoms of gastric derange- 
ment, the giddiness and cephalalgia returned. Decoction of nymphea in in- 
jections, and the presence of a catheter in the urethra for an hour or two at a 
time, caused these nocturnal and diurnal pollutions to diminish considerably, 
but the coincidence of new disorders accompanying the return of the pollu- 
tions, left no doubt as to the origin of the disease, and I therefore advised 
cauterization. This was performed some time afterwards, and still later, I 
used acupuncture. 

These means produced a profound and lasting change in the functions of 
the spermatic organs, for, from this time, the nocturnal pollutions became 
more and more rare, and the urine rarely contained either spermatic deposit 
or mucous cloud. The other symptoms also gradually diminished from 
this period, clearly showing that they arose from involuntary seminal dis- 



CONGENITAL PRE-DIS PO SITION. 243 

charges. The attacks of giddiness disappeared so completely, that M. M- 



in travelling through Switzerland shortly after, was able to pass on a mule 
along narrow precipices, and on the brink of torrents, without suffering the 
least inconvenience. 

M. M , being convinced of the return of all his functions, has mar- 
ried, and became a father a few months since. 

From the conclusion of this case, it is impossible to doubt the true 
cause of the gastric and cerebral disorder, and it is evident, that their 
habitual coincidence was owing to their arising from the same cause. 
The frequent intermittences of the disorder are not wonderful after 
the cases I have already related, besides, during these intervals of a 
month or two at a time, the health was never perfectly re-established. 
The patient was only less ill than usual. Before having severe at- 
tacks, too, the patient had suffered from slighter ones, to which he paid 
no attention, but which only differed from those which occurred after- 
wards in their intensity and duration. 

M. M had complained for a long time of dull and wandering 

pains in his testicles, painful erections, and frequent debilitating noc- 
turnal pollutions. If therefore his medical attendants had paid at- 
tention to these symptoms, they must soon have discovered the cause 
of his disorder. 

It was impossible to mistake the influence of blennorrhagia in ex- 
citing these nocturnal and diurnal pollutions, and I did not seek any 
other cause; but Dr. Guillemot sent me some very judicious obser- 
vations, which I must mention here. M. M 's father was always 

an invalid; he was subject to frequent and obstinate catarrhs; his 
appetite was irregular and his stomach very inactive. The state of 
his digestion, too, exercised great influence over his character. All 
his family noticed the analogy between his symptoms and those of 
his son. 

M. M has also a brother who resembles him physically as well 

as morally, and who suffers from frequent but less severe attacks of 
giddiness. He is also subject to nocturnal pollutions, especially when 
travelling, and Dr. Guillemot has often found traces of spermatic de- 
posit in his urine. He is frequently constipated, and passes a certain 
quantity of semen during his efforts at stool. He is subject also to 
eruptions on the glans and prepuce. For these symptoms he has 
quite recently consulted me, The similarity, of these circumstances 
recurring in M. M -'s father and brother is worthy of notice ; in- 
deed, there is no reason why the genital organs should not partake 
of the family resemblances, that exist in features, height, tempera- 
ment, &c. 

I think, therefore, that in this case the involuntary discharges, and 
the serious disorder to which they gave rise, depended more on here- 
ditary predisposition than on the blennorrhagia. 

The following is a very remarkable circumstance of the same kind, 
which came under my notice in 1830. 



244 CAUSES OF SPERMATORRHOEA. 

CASE LXIL 

Nocturnal and, diurnal pollutions occurring in three brothers. 

In 1822, M. C , set. nineteen, suffered from frequent nocturnal pollu- 
tions, although he had frequent sexual intercourse. One night on awaking 
he endeavoured to prevent ejaculation from taking place, by firm pressure on 
the bed; he succeeded; but the next morning, without any other evident 
cause, the passage of urine was painful; the second day the pain in the 
urethra increased; the patient had discharge, fever, dysuria, and even stran- 
gury. These symptoms lasted a month and more, their severity being, how- 
ever, diminished by demulcent drinks, local and general baths, and a strict 
regimen. Before the patient was quite well he attempted coitus, which was 
accompanied with severe pain in the urethra. A little while after there was 
abundant deposit in the urine. 

In 1823, after a very tiring walk, this patient experienced a lively burning 
in the urethra during the passage of urine. The discharge, too, returned, 
but passed off without any treatment. During the five years following, 
although he was strictly continent, he suffered from constant burning in the 
urethra, with from time to time dysuria, pain in the loins, and abundant de- 
posit in the urine. 

In 1829, he was in a state of profound melancholy and depression; he 
suffered from difficulty of breathing, a sense of weight at the epigastrium, 
anorexia, frequent liquid stools, and heavy pain in the lumbar and hypo- 
gastric regions. Whenever he went to stool, a considerable discharge of 
watery semen took place, and the same thing happened frequently during the 
emission of the last drops of urine, as well as after he had experienced the 
least venereal excitement, although he had not had erection. The prostate 
was not enlarged, but painful on pressure. 

This patient's elder brother, aet. twenty-five, of robust constitution and 
remarkable muscular strength, possessed active virility at the age of nine- 
teen, when he had daily meetings with a female whom he endeavoured to 
seduce, often renewing his attempts three or four times in a few hours. At 
first obstacles only arose from the pain caused,, and the unfavourable cir- 
cumstances that accompanied these meetings, but after a time his erections 
became incomplete, ejaculation took place very rapidly, and at last took 
place on the first approaches. Afterwards he addressed himself to other 
females, but then he perceived that his erections were incomplete, rare, and 
of short duration; he experienced frequent and almost passive nocturnal 
pollutions, with pain in the testicles and spermatic cords, and at last, in- 
voluntary discharges during efforts at stool; his health, however, was not 
much disordered. 

The younger brother, set. nineteen, also suffered from nocturnal pollutions 
without erection, involuntary discharges at stool during the emission of urine, 
and even while in company with a female. These he attributed to consider- 
able ungratified venereal excitement, which he had experienced daily for a 
long time together. 

The coincidence of nocturnal and diurnal pollutions in three 
brothers, the eldest set. twenty-seven, the youngest nineteen, is re- 
markable enough; — all three being strong and well made. It is 
worthy of note also that the gravity of the symptoms was exactly pro- 



CONGENITAL PR E-DISPO SITION. 245 

portioned to the age of the individuals, and consequent^', to the du- 
ration of their disease ; for it seemed to have commenced in each 
case at about the same age. 

The causes which favoured the development of the disease in these 
three brothers were too slight in each case not to require the hypo- 
thesis of congenital disposition to account for its appearance. Cases 
of this kind are rare, but those above related are sufficiently charac- 
teristic to leave no doubt of the possibility of hereditary pre-dispo- 
sition to involuntary discharges existing without any sign in the 
genital organs denoting its presence. 

Congenital increased Nervous Susceptibility. — I have met with a 
considerable number of patients in whom involuntary discharges were 
referrible rather to an originally excited sensibility of the genital 
organs, than to congenital relaxation. None of these patients had 
been exposed to the influence of any cause sufficient to account for 
the occurrence of spermatorrhoea. 

In general such patients were of sickly constitution, and more or 
less marked nervous temperament; they had been delicate from child- 
hood, and subject to various spasmodic disorders. Some of them 
presented involuntary twitching of the muscles of the face, hesitation 
of the speech, &c. ; their imagination was active, and their moral 
and physical sensibility very acute. They were very restless, and 
bore contradiction, or mental excitement, badly. 

In childhood they presented local symptoms, which indicated 
peculiar susceptibility of the urinary organs, every impression of fear 
or anxiety showing itself in this direction. What would have pro- 
duced shuddering, or palpitation in other children, in them caused a 
secretion of clear watery urine, which they were obliged to discharge 
frequently ; a sense of constriction of the hypogastrium, and a sense 
of titillation generally accompanied its discharge. This condition of 
the urinary organs continued more or less severe in all the cases 
until after puberty, when it became joined with other symptoms. 
One of these patients one day experienced at the age of sixteen a fit 
of irritability and impatience, which, however, he succeeded in re- 
pressing; and he then felt sudden and impetuous desire of micturi- 
tion : whilst emptying his bladder he perceived a large quantity of 
pure semen discharged with the last drops of urine. This occurrence 
was the forerunner of nocturnal and diurnal pollutions, which at the 
age of twenty-seven had entirely ruined his health. Another, at the 
moment of competition for a college prize, was unable to find an ex- 
pression he wanted: at the same time he felt a want to make water, 
which he resisted by firmly crossing his legs; but his impatience in- 
creased, and he shortly experienced an abundant emission without 
either erection or pleasure. A third patient suffered in the same 
way under similar circumstances ; he saw the moment approach for 
sending in his thesis ; the more he endeavoured to hurry the less freely 
his expressions flowed; at length, on hearing the clock strike, he 
suffered from so great mental disorder that he nearly fainted; at this 



246 CAUSES OF SPERMATORRHEA. 

moment emission took place. A fourth having mounted on a high 
gutter of a house to take some sparrows' nests, looked down into the 
court below, and was suddenly seized with such terror that he fainted; 
on recovering and escaping from his dangerous situation he found that 
he had had an abundant seminal emission. The same circumstance 
occurred to a fifth, ,who, in descending a ladder, missed his footing 
and fell. Another patient told me that if he looked down from a 
height, or only fancied himself on the brink of a precipice, he felt 
a sense of contraction in the genital organs, which passed rapidly 
to the base of the penis, and ended by causing emission. The motion 
of a swing produced the same effects in a seventh. 

Almost all these excitable persons were exposed to erection, and 
even to pollutions whenever they rode on horseback. 

Although all these involuntary discharges were caused by extraor- 
dinary circumstances, I should not have paid much attention to 
them if they had not been followed by nocturnal and diurnal pollu- 
tions, which the most trifling circumstances rendered very serious. 
The disease, however, did not always put on a serious aspect imme- 
diately after these singular accidents; very often, indeed, it only in- 
jured the patient's health long afterwards ; but as its gravity could 
not be explained by any occasional cause, I feel myself compelled to 
admit the existence of a congenital increased nervous susceptibility 
of the genito-urinary organs. Every thing indicates, in fact, that the 
organs of these patients were rather excitable than weak and relaxed; 
and this condition was congenital because manifested from the earliest 
infancy. This excessive sensibility of the genital organs is, however, 
not always preceded by a similar condition of the urinary apparatus. 

In all these cases, tonics and excitants always produced bad 
effects; proving that the genital organs were not suffering from 
atony. 

Long -continued Continence. — I have already shown the vast ad- 
vantage of chaste habits, strict principles, and moderate desires; I 
have now to point out the inconveniences resulting in certain cases 
from absolute and long-continued abstinence from sexual intercourse. 
The effects produced by complete privation afford the most certain 
evidence of the original strength or debility of the genital organs. 
If they are powerful, such privation proves a kind of torture which 
may induce the most serious abuses, or disorder in all the functions; 
if irritable, prolonged abstinence causes abundant and frequent 
nocturnal pollutions; if weak and little developed, such privation is 
not painful; the pollutions are rare and in small quantity at first, but 
still they produce a serious effect, and after a time they become more 
and more severe and difficult of cure. 

These signs of energy, irritability, or weakness in the genital or- 
gans, are more certain than those drawn from their external ap- 
pearance. 

The patients of whom I am about to speak are all remarkable for 
the facility with which they support privation from sexual intercourse. 



CONGENITAL PR E-DISPO SITIO N. 247 

Their lives are exemplary in all respects ; not only have they never 
committed excesses or practised abuse, but for the most part they have 
never even had any relations with the opposite sex. In these cases 
the temptation is so slight that to conquer it is not any great merit. 
Such constant and easy continence is an unfavourable sign when 
considered in reference to the powers of the genital organs ; and we 
should much deceive ourselves if we adopted, without examination, 
the explanation the patients give of their conduct. They generally 
attribute their continence to strict morality, to religious principles 
inculcated in early infancy, or to the effects of good example ; they 
omit altogether to mention the little desire they have had to combat. 
But when such patients wish to break their long and easy continence, 
they find themselves completely unable ; not on one occasion only, 
but habitually; not under unfavourable circumstances, but during 
many years of marriage. Such a state of things during the period 
of the greatest virility completely explains the ease with which 
they maintained their former long continence. Most of these pa- 
tients, too, feel a strange presentiment of the catastrophe which 
awaits them. They have a suspicion of their weakness, and hence 
they manifest an instinctive repugnance to marriage, and hesitate 
long before they are able to make up their minds to enter that state. 

A great facility, then, of supporting absolute continence, ought to 
lead us to suspect want of power in the genital organs ; as well as 
diurnal pollutions when nocturnal ones do not occur, because the 
continued presence of semen will stimulate the least powerful organs 
into occasional action. 

Let us now see what are the effects of such long continence, es- 
pecially in these weak individuals. If fatigue be hurtful to all 
organs, so moderate exercise is necessary to them as soon as they 
are in a condition to act. The generative organs are not beyond 
the influence of this general law. All surgeons admit that prolonged 
inaction produces the same effects on the genital organs as on any 
other ; that is to say, that it diminishes their energy and activity. 
The inactivity of these organs in children and eunuchs arises from 
the non-secretion of semen; no pollutions can therefore arise in such 
cases, and the health does not become disordered. On the contrary, 
in the unmutilated adult, want of power can only be attributed to 
very serious diurnal pollutions often very difficult of cure. As soon 
as the evolution of the genital organs commences, the testicles begin 
to act; if their structure be not accidentally injured, they continue 
to secrete until a very advanced age. This secretion, it is true, may 
be diminished by the absence of all excitement, direct or indirect, or 
by momentary weakening of the system, or by the special action of 
certain medicines ; but it never ceases entirely from the age of pu- 
berty to the commencement of old age. Hence results an evident 
deduction, viz. : that in the absence of all voluntary evacuation the 
seminal vesicles must become filled more or less rapidly, and after a 
time must become distended; so that if the secretion be not evacu- 



248 CAUSES OF SPERMATORRHOEA. 

ated in quantity in an open and sudden manner, it must escape by 
degrees at periods more or less close, and under circumstances which 
render this evacuation difficult to be ascertained. In other words, if 
nocturnal pollutions do not occasionally occur, it is because diurnal 
ones exist. 

From the numerous cases I have related it is evident how slow 
and insidious the progress of this disease may be, and it is remark- 
able that those who have fallen into the most deplorable condition, 
and whose cure has been most difficult, have been precisely such as 
had supported the disease longest without suffering much. 

In studying the cases attentively it becomes evident that the dis- 
ease commences by nocturnal pollutions, accompanied with lascivious 
dreams, energetic erections, and a lively sense of pleasure. But this 
orgasm diminishes by degrees, and the emissions at last take place 
without erection or sensation ; such nocturnal pollutions become 
more rare, and sometimes cease entirely, and then the health of the 
patients becomes seriously and rapidly affected, much to their 
astonishment, as they have no suspicion that diurnal pollutions have 
been added to the nocturnal ones, and at last have entirely taken 
their place. 

By reflecting on the succession of the phenomena in individuals 
who have done nothing to aggravate their condition; and taking 
into the consideration the salutary effects which sexual intercourse 
produced in many of the cases that have come under my notice, (see 
case fifty-six) it is impossible not to admit that prolonged inaction of 
the genital organs diminishes the tonic resistance of the ejaculatory 
ducts, disorders their sensibility, and perverts their functions, without 
being able to prevent the formation of semen by the testicles, or its 
passage into the seminal vesicles. Absolute continence, therefore, 
renders the expulsion of semen more and more easy in these cases 
without diminishing its secretion in an equal proportion. 

The striking and numerous cases of this kind that I have met with 
leave no doubt on my mind as to the true cause of the deceitful calm 
of the genital system. The erections and the desires undoubtedly 
cease ; impotence is established ; the organs no longer give the least 
sign of activity ; nothing can remove their torpidity : all this is incon- 
trovertible : but this condition is far from one of rest, especially of 
reparative rest ; no advantage to the economy can result from it, in 
whatever manner the other functions may be performed ; it is truly 
a pathological state; and it may exist long without appearing seri- 
ous or sensibly affecting the constitution. But it becomes aggra- 
vated with the prolongation of the continence, and grows daily more 
difficult of cure. 

The good health of such patients is only apparent ; the least cir- 
cumstances disorder it, and what they suffer is unsuspected ; their 
parents, their most intimate friends, are ignorant of the cause of the 
various disorders they complain of; the medical man who possesses 
their confidence is not better informed, because the patients them- 



CONGENITAL P RE-DISP S ITION . 249 

selves do not suspect it; thus their indispositions are set down to 
ennui, tendency to melancholy, or hypochondriasis. When their 
diseases become more serious, their constitutions are said to be deli- 
cate, impressionable, or unhealthy, or they are considered malades 
imaginaires. They are told that they pay too much attention to 
themselves, or that they have fondness for medicines. Medical men 
in large practice get tired of hearing their long series of inexplicable 
complaints, and get rid of them by advising travelling, or change of 
air. Charlatans rob them ; officious friends advise marriage, or oc- 
cupation to fill the void in their existence ; every one blames, because 
no one understands them. Incapable of all serious occupation or 
deep affection, they grow discontented with themselves and still more 
so with others ; absorbed by one sole thought, they return unceasingly 
to themselves to seek the cause of their condition, and soon become 
misanthropical. 

When the disease has arrived at this point, it must make progress, 
because the normal exercise of the organs is indispensable to give 
them tone and to put an end to the involuntary seminal discharges ; 
but these no longer permit the erectile tissues to pass out of their 
torpidity. We must, therefore, commence by arresting these pollu- 
tions ; but w T hen they have become diurnal their existence is easily 
mistaken, and their cure is more difficult in proportion as the period 
of inaction has been more prolonged. 

Prom these facts it results that the least excitable and the most 
continent and timid individuals are precisely those for whom habitual 
continued continence is most injurious; they endure it with less im- 
mediate inconvenience than others ; and although any excess would 
be very prejudicial to them, absolute privation possesses the greatest 
dangers. In fact, natural moderate exercise can alone give to their 
organs sufficient energy, and sufficiently regular habits to arrest noc- 
turnal pollutions, and to prevent the occurrence of diurnal ones. No 
one would think of depriving a delicate child of exercise simply be- 
cause he shows less disposition for it than his companions. Every 
one, on the contrary, would understand that it is the only means by 
which his weak constitution can be strengthened, if not rendered 
hardy. The same reasoning holds good in respect to the cases under 
consideration. 

General Review of the Causes of Spermatorrhoea. — It has 
been seen that the causes of involuntary seminal discharges are very 
numerous, and that their mode of action varies much. Hippocrates 
wrote only of venereal excesses. Tissot and his successors added 
masturbation — the incompleteness of this list is evident. These two 
causes were supposed to act invariably in the same manner ; whereas 
I have proved that their influence varies in different individuals, and 
even in the same individual at different times. All pollutions, too, 
whether nocturnal or diurnal, were referred to relaxation of the geni- 
tal organs; but I have shown that a very opposite condition produces 



250 CAUSES OF SPERMATORRHEA. 

the same effects ; indeed, that this supposed relaxation seldom exists 
alone, especially under the circumstances stated. 

I will now briefly recapitulate these causes. The first I considered 
was blennorrhagia — tracing the inflammation from the orifice of the 
glans penis, and considering all the changes produced by it in the 
tissues. Secondly I spoke of cutaneous affections, pointing out the 
mode in which, by propagation of the cutaneous irritation through 
its continuity with the mucous lining of the urethra, involuntary se- 
minal discharges arise. Thirdly, I considered the influence of the 
rectum. This I divided into two kinds : the -one being mechanical, 
arising from an obstacle to defecation or from constipation, the other 
a vital action, producing its effects by the extension of irritation 
from the rectum to the prostate and seminal vesicles. The fourth 
cause of which I treated, was abuse: Here I pointed out the various 
causes of abuse, their importance, and the varieties of abuses. On 
these points I laid considerable stress, on account of their importance 
to the well being of the human race ; I also pointed out the effects 
of abuses, and the means to be taken to prevent them. The fifth 
cause that came under my notice consisted of venereal excesses, and 
here I showed the circumstances which constitute excesses, and the 
conditions in which slight sexual intercourse may be injurious. I 
showed also, that factitious desires may arise and carry intercourse 
beyond the actual wants of the system. The general and special 
effects of venereal excesses also occupied my attention. Sixthly, I 
considered the action of certain medicines inducing involuntary se- 
minal discharges. I showed the effects of astringents, purgatives, 
and medicines which stimulate the urinary organs, such as nitrate of 
potass, &c. I also mentioned the action of coffee and tea, when 
taken in excess. Seventhly, the action of the cerebrospinal system 
occupied my attention. I here considered the action of the cerebellum 
and spinal cord. Eighthly, I considered congenital predisposition ; 
and here malformations came under my notice, with phimosis, ex- 
uberant prepuce, vitiated secretion of sebaceous matter, hereditary 
predisposition, congenital debility, &c. I also passed rapidly over 
the symptoms by which debility of the genital organs may be recog- 
nised, and the conclusions to be drawn from incontinence of urine 
during childhood. I also made a few remarks on disorders of ner- 
vous susceptibility, and on the effects of continence on cases in which 
the genital organs are originally in an atonic condition. I have, in 
this first part of my work, related many cases — too many perhaps to 
suit the taste of some readers — but I found myself under the neces- 
sity of treating the subject of involuntary discharges as an entirely 
new one, and of proving each proposition as I proceeded—the scanty 
writings on the subject that have hitherto appeared, being not only 
useless, but worse— full of errors. 



LOCAL SYMPTOMS. 251 



CHAPTEE XI. 

SYMPTOMS OF SPERMATORRHEA 



I have hitherto been occupied only in considering the causes of 
spermatorrhoea; its symptoms now claim more special attention. 

A cursory glance at the symptoms of involuntary seminal discharges 
is sufficient to show, that some may be referred exclusively to the 
genital organs, while others extend to all the functions of the system. 
The first constitute the disease, the second are only its more or less 
remote consequences. I divide the symptoms, therefore, into two 
great groups of local and general symptoms, in order to approximate, 
in their natural position, those phenomena which are most nearly 
connected among themselves. Both divisions are, nevertheless, in- 
timately connected. 

While considering these symptoms singly and in order, I shall 
avoid all those subtle divisions that have been proposed, into pollu- 
tions attended with erection, pleasure, spasmodic contraction, &c. ; 
such being, in my opinion, only useless complications of the subject. 

LOCAL SYMPTOMS. 

Nocturnal Pollutions. — Those involuntary discharges that take 
place during sleep are easily ascertained; but it is not always so 
easy to appreciate the degree of importance to be attached to them, 
because they are not all equally injurious ; under some circumstances 
they are even useful. The most abundant nocturnal pollutions are 
far from being always the most hurtful. When they arise from true 
spermatic plethora, they, often relieve erotic excitement, with its ac- 
companying agitation, anxiety, uneasiness, and indefinable trouble in 
all the functions. They are followed by a general feeling of comfort ; 
the head becomes clearer, the ideas more rapid, and the motions more 
nimble ; there is more inclination to amusement, and to every kind of oc- 
cupation. I admit that nocturnal pollutions do not often produce such 
good effects, but then they are not often the result of spermatic ple- 
thora; they may, too, easily lose their character, so that habit alone 
tends to make them more and more frequent. In the greater number 
of cases, however, these evacuations are of very little importance. 

But this state of excitement is too violent to last long : by degrees 
the organs become fatigued. Deprived of their natural functions, 



252 SYMPTOMS OF SPERMATORRHEA 






and consequently, being un strengthened by regular exercise, they 
may at last fall into a state of atony, or the seminal vesicles may pre- 
serve the habit of contracting, under the influence of slight or indirect 
exitement. The evacuations now produce effects quite opposite to 
those experienced in the beginning. There are, on waking, feelings 
of discontent, idleness, weight in the head, disorder in the ideas, &c, 
but this condition passes off in the course of the day, and the patient 
is quite well on the following morning, if no further emission take 
place. After a time, these effects become more serious and lasting, 
and two or three days are required to remove them completely. 
There is, however, no disease as yet, because the economy is not as 
yet permanently disordered ; but there is a degree of instability in 
the patient's health, a valetudinary condition, the progress of which 
it is necessary to arrest. 

In these simple and early cases moderate coitus is useful ; it gives 
tone to the organs, and breaks off the habit of involuntary emissions. 
At a later period coitus has its dangers. 

When nocturnal pollutions are excited by abuse, by venereal ex- 
cesses, or by the irritation of ascarides, they frequently produce serious 
disorders soon after their appearance, and the disease rapidly pro- 
gresses. By degrees all the phenomena of excitement which preceded 
or accompanied the crisis, disappear entirely; emission occurs with- 
out dreams, erections, pleasure, or indeed, any particular sensations ; 
so that the patients only discover what has taken place by finding the 
marks on their linen when they awake. At the same time, the seminal 
fluid loses its consistence, colour, smell, and even spermatozoa, by 
degrees, and more and more resembles mucus or prostatic fluid. It 
is impossible to doubt its identity, however; the changes take place 
slowly, and frequently patients are able to follow their progress. 
These watery evacuations are followed by similar but more violent 
effects ; besides, the seminal vesicles alone can furnish so abundant a 
discharge of viscid matter. The emission is sudden, the patients 
never having a constant seminal discharge. A similar evacuation 
does not always take place every night, though sometimes discharges 
may happen frequently in one night; and this the patients are easily 
able to ascertain, because their sleep is light and broken. As to the 
absence of erection during these discharges, it cannot be doubted, as 
the matter is found in the hair around the base of the penis, in the 
perineum, and even on the thigh. When it becomes dry after flow- 
ing over the skin, it forms a thin, brilliant pellicle, resembling the 
mark left by the garden snail. Generally, a good deal of this matter, 
too, is found on the interior of the prepuce ; sometimes even the pre- 
puce is entirely filled with it, showing the flaccidity of the penis, and 
the little energy of the seminal vesicles. This kind of progressive 
decrease in the excitement of the genital organs, with the correspond- 
ing increased alteration in the qualities of the semen, is accom- 
panied with notable increase in the severity of the general symptoms, 
and in the difficulty of treating them. 



LOCAL SYMPTOMS. 253 

In nocturnal pollutions, and, indeed, in all involuntary seminal 
discharges, the semen rarely undergoes any other alterations than 
those of which I have spoken; even when the patients have prac- 
tised masturbation or coitus so furiously as to cause emissions of 
blood. I have only met with one case in which the pollutions were 
sanguinolent, and that only for a few days. The semen is also rarely 
purulent or sanious, at least during any length of time, in patients 
affected by involuntary discharges ; such characters evince a pro- 
found lesion of the spermatic organs, which would be soon followed 
by death if it continued in so great intensity. It often happens that 
ordinary spermatorrhoea follows these sanguinolent or sanious emis- 
sions ; but so long as the disease preserves the characters of a sim- 
ple inflammation it must be considered as such, and treated accord- 
ingly. The effects of nocturnal pollutions are generally supposed 
to be proportioned to their abundance, frequency, and the energy 
of the phenomena that precede and accompany them : this conclu- 
sion is, however, extremely false. In all the cases of nocturnal pol- 
lutions related by authors, occurring critically, and putting an end 
to alarming symptoms, the discharges have been very copious, and 
often repeated in a single night. It may easily be conceived, there- 
fore, that it is only in an extreme state of spermatic plethora that 
such frequent discharges can take place. But, putting aside these 
exceptional cases, we may often be deceived as to the importance of 
nocturnal pollutions when considered only with respect to the 
abundance and frequency of the discharges; for the virile powers 
vary much in different individuals, and we have no certain means of 
establishing the relation between this power and the constitutional 
strength of the patient. Besides, on the other hand, it is generally 
when the pollutions become less frequent and abundant that they are 
followed by serious and long continued general symptoms. This 
anomaly is, however, only apparent, because the nocturnal pollutions 
become joined with diurnal ones that occur insensibly. It is, there- 
fore, of importance to warn both surgeons and patients of the errors 
they commit daily in estimating the value of nocturnal pollutions 
by their abundance and frequency. 

It is generally believed that erotic dreams excite nightly dis- 
charges, and they are consequently considered very dangerous. But 
the lascivious images that present themselves during sleep arise from 
excitement of the genital organs in the same way as the erections 
and the contractions of the seminal vesicles. These phenomena all 
coincide; they all arise from the same cause; but one does not de- 
pend on the other. 

Two kinds of these dreams may occur: the one arising from true 
spermatic plethora, and presenting pleasant images unmixed with any 
disagreeable sensation ; the other, excited by irritation of the organs, 
and mingled with filthy or disgusting ideas. After a time too these 
dreams may degenerate into true nightmare, accompanied with ter- 
rible sensations and difficulty of respiration, and in the middle of 



254 SYMPTOMS OF SPEEMATORRH(EA. 






the agitation the seminal emission takes place unaccompanied by any 
lascivious idea or voluptuous sensation. The danger commences when 
the erotic dreams diminish in vigour, and their return is one of the 
most certain signs of improvement. 

The same thing may be said of the energetic and long-continued 
erections, and the active contractions that take place under similar 
circumstances. The diminution of the energetic phenomena alone 
should cause uneasiness, the most debilitating discharges, and those 
most difficult of cure being those that take place most passively. 
The more the seminal fluid too loses its distinctive characters and 
becomes watery, the more hurtful are the effects of the discharges 
on the system. 

Diurnal pollutions are distinguished from nocturnal ones by their 
taking place during the waking state. They may be divided into 
two classes: those that happen during defecation, and those that 
occur during the emission of urine. 

The diurnal pollutions that happen during defecation are more 
easily discovered than those that take place during the emission of 
urine ; they do not, however, always constitute a disease, although 
they can never be critical or useful like certain nocturnal pollutions. 
So long as they happen rarely, and are accidental, the health is not 
injured; but when they do not cease on the removal of the acci- 
dental exciting cause, they incline to become more and more fre- 
quent, and to continue from habit, and after a time constitute a 
disease which may become serious and obstinate. The transitions 
are sometimes so insensible, that it is difficult to establish fixed cha- 
racters for them, which shall be constantly applicable to practice. 

When a robust individual has been submitted to unusual conti- 
nence, and to the long continued motion of a carriage, he may ex- 
perience, after a few days' travelling, an abundant discharge of semen 
during the violent efforts excited by accidental constipation. This is 
not a matter for much alarm ; all will disappear as soon as the cause 
is removed. But habitual and constant travelling in a carriage may 
bring on permanent constipation, and a habit of involuntary dis- 
charges, very difficult to break off. The diminution of the erections 
under these circumstances is not always attributable to the genital 
organs becoming accustomed to the heat and motion of the carriage ; 
but very often to the frequent repetition of unnoticed diurnal pollu- 
tions. The same thing may happen with respect to daily and long 
continued horse exercise. Generally the organs habituate themselves 
to the action, but occasionally diurnal pollutions come on, and do 
not readily pass off, although their cause may have been removed. 

The same may be said of the effects of long continued sitting, in 
literary men and others. After having produced increased heat in 
the margin of the anus and perineum, with frequent and prolonged 
erections, sedentary habits are often followed by a completely oppo- 
site condition, without the transition from one state to another being 
appreciable. The long use of astringents and bitters, together with, 



LOCAL SYMPTOMS. 255 

in fact, all causes capable of inducing constipation, tend equally to 
transform diurnal pollutions, which were harmless at first, into serious 
and intractable disease. 

In all cases of this nature it is not habit alone that tends to perpe- 
tuate the evacuations; there is also want of power in the rectum, 
which continues to increase in proportion as the system becomes 
weaker. Defecation requires the assistance of powerful efforts of the 
abdominal muscles, and this produces compression of the seminal 
vesicles. 

On the other hand, all causes irritating the rectum may produce 
spasmodic contractions in the seminal vesicles, so that diurnal pol- 
lutions may be produced as well during diarrhoea as during consti- 
pation : such an effect is generally of short duration ; but it may be- 
come permanent provided the rectal irritation be long continued, or 
return frequently. Such susceptibility of the seminal vesicles, too, 
announces an unfortunate disposition to the occurrence of these dis- 
charges ; and this is the point of chief importance in the considera- 
tion of pollutions produced by a hot, cold, or irritating injection, by 
an active purge, &c. 

The same remarks hold good when applied to the pollutions ex- 
cited by hemorrhoids; very often they only come on when such 
hemorrhoids are increased accidentally, but they may continue after- 
wards and even become habitual. 

In all cases such as I have just been considering, it is for the prac- 
titioner to appreciate the importance to be attached to the discharges, 
and it is by their effects that he must judge them, rather than by 
abundance; for some patients support their effects better than others, 
and the danger varies according as they are accompanied or not with 
other pollutions — as, for instance, with those that occur during the 
discharge of urine. 

The seminal vesicles sometimes contract from sympathy, rather 
than from being compressed by the rectum. This is easily observed 
in some patients who never pass semen during the efforts at defeca- 
tion, but only after the passage of faeces, and even sometimes whilst 
adjusting their dress. In such cases a sudden convulsive shock is 
felt between the perineum and neck of the bladder, sometimes with 
slight turgescence of the penis and a certain amount of pleasure; and 
the fluid is discharged by two or three spasmodic contractions which 
may even project it a short distance. If these discharges always oc- 
curred after defecation they would be as easily discovered as noc- 
turnal pollutions, for the fluid could not escape the patient's observa- 
tion. But such cases are the rarest; and in all others the discharges 
are generally the less suspected in proportion as the disease becomes 
more serious. In fact, at first, when the discharges depend on long 
continence, accidental constipation, &c, they are very copious, and 
generally attended with more or less turgescence of the penis and 
slight sensations, which attract attention. The semen, too, possess- 
ing its normal characteristics, cannot be mistaken in these cases, and 



256 SYMPTOMS OF SPERMATORRHEA. 

the sensation it produces in passing through the urethra is very dif- 
ferent from that excited by the passage of urine. But as I have 
before stated, in proportion as the disease progresses, the#semen 
becomes more aqueous; it is expelled with less effort and less 
copiously. Thus, supposing that the small quantity of fluid dis- 
charged be not passed together with the urine, the patient may 
imagine that he has only passed mucus or prostatic fluid — an opinion 
which, if he mention the circumstance to his medical attendant, is 
very likely to be confirmed. 

It is well known that after violent efforts at defecation, a small 
quantity of viscid matter may be expressed from the follicles of the 
prostate, and may form, with the mucus of the canal, a drop of 
thick and stringy fluid which stops at the orifice of the glans; but 
is this the reason why every one who states that he has passed se- 
men while at stool should have his assertion contradicted without 
examination? This, nevertheless, happens daily. Patients who 
take the precaution of emptying the bladder before going to stool, 
are not to be so easily deceived; for the prostatic fluid, joined with the 
urethral mucus, never furnishes more than one or two drops of thick 
thready matter, which is almost always transparent; and the most 
simple reasoning suffices to show that these fluids never can be expelled 
in any quantity at one time, because they have no reservoirs to ac- 
cumulate in. Whenever, therefore, a quantity of fluid amounting to 
a spoonful is expelled at once, there can be no chance of its con- 
sisting merely of prostatic fluid and mucus. 

Seminal discharges that take place during the emission of urine 
are the most serious and most obstinate of all, because they are the 
most often and most easily repeated. They are also very obscure 
on account of the alterations the semen undergoes, and of its mix- 
ture with the urine — at least, in the majority of cases. I must there- 
fore lay considerable stress on the means by which the presence of 
these discharges may be ascertained. 

First, the semen never mixes with the urine at the commencement 
of the discharge. It only escapes with the last drops, and when the 
bladder finishes emptying itself by energetic and spasmodic contrac- 
tions ; sometimes even it escapes by itself after the bladder has been 
completely emptied. The desire of making water occurs very often 
in these cases, and sometimes, though comparatively seldom, the 
penis becomes slightly turgescent, and two or three convulsive mo- 
tions expel the fluid in jets. Generally, however, there is no in- 
terval between the discharge of urine and the seminal flow, and the 
phenomena are so connected that they cannot be separately distin- 
guished. I have verified the fact of the semen being only expelled 
during the last contractions of the bladder, so often, however, that 
there can be no doubt on the point. 

Habitual gleet is liable to become aggravated from very slight 
causes, and may give rise to a cloud in the urine, which it is possible 
may be taken for seminal fluid; to avoid this error, it is sufficient to 






LOCAL SYMPTOMS. 257 



recollect that in gleet it is always the first jet of urine that is cloudy 
— the cloud consisting of cast off epithelial scales, mucus, and pros- 
tatic fluid, which have accumulated since the previous act of micturi- 
tion. Whenever the bladder, too, contains blood, pus, mucus, &c, 
these extraneous matters, being heavier than the urine, are collected 
near the neck of the bladder, and consequently are discharged first 
when the patient is standing. The contrary takes place with regard 
to semen. These remarks will be found of considerable importance 
in practice, for gleet and vesical catarrh are often present at the same 
time with diurnal pollutions, and render the diagnosis very obscure. 
In simple and early cases, on desiring the patients to make water in a 
bath, it is very easy to distinguish the semen discharged with the last 
drops. In such cases it possesses considerable opacity, and contains 
a number of granules which become dispersed in the water, troubling 
it very considerably. In older cases it is still easy by a little atten- 
tion to prove the presence of semen: — the urine suddenly acquires 
greater density; besides, the semen is seldom so totally changed as 
no longer to contain whitish particles, or distinct granules. 

It must be borne in mind, however, that the variations are very 
great between one day and another, so that pollutions may not be 
noticed on every occasion. 

In most cases the presence of semen in the urine may be disco- 
vered at the first view. In cases that are recent, small semi-trans- 
parent irregularly spherical granules of variable size, somewhat re- 
sembling bran, are seen at the bottom of the vessel. These cannot 
be confounded with any urinary salt, because they appear before the 
fluid has cooled; they are soft, and do not adhere to the sides of the 
vessel. On the other hand, neither urethra, prostate, bladder, nor 
kidneys can furnish similar granules, especially when the urine is 
transparent; they must come, therefore, from the seminal vesicles, 
and may be regarded as a sure proof of diurnal pollutions. The pa- 
tients too are generally made aware of the passage of the semen by 
a peculiar sensation, arising from the unaccustomed density of the 
urine; they often distinguish also the spasmodic contractions of the 
seminal vesicles which produce these diurnal pollutions. It is wor- 
thy of remark too that such pollutions occur almost always after 
some venereal excitement, as, for example, after an erotic dream, 
lascivious conversation, &c. ; or, after some mechanical excitement 
of the genital organs ; and often while the erectile tissues are more 
or less turgescent, the desire of micturition is felt. The union of 
these circumstances sufficiently indicates that such pollutions are the 
least passive of those that occur during the passage of urine; they 
are also the least serious and the most rare. 

Other patients experience very different phenomena. The penis 
shrinks towards the pubes in consequence of the pain that extends 
from the neck of the bladder to the glans. The passage of the urine 
over a very irritable point of the canal causes the spasmodic con- 
tractions into which the sphincters and seminal vesicles soon enter. 
17 



258 SYPMTOMS OF SPERMATORRHEA. 

Different sensations sometimes announce the occurrence of a pollu- 
tion ; sometimes it is a sense of heat at the margin of the anus; 
sometimes a shiver or general uneasiness; and, occasionally, a dart- 
ing pain in the nipple, &c. Patients who are accustomed to these 
particular occurrences well know that they will find a deposit of 
flocculent matter in their urine after experiencing them. 

When the disease has made further progress the passage of the 
semen is hardly appreciable by the patients, and the urine no longer 
deposits such large granules at the bottom of the vessel. There is, 
however, a thick homogeneous whitish cloud sprinkled with little 
brilliant points which descend to the bottom of the vessel, and have 
been compared, with justice, to the deposit formed in a strong de- 
coction of barley or rice. Repeated microscopic examinations have 
left no doubt on my mind that such clouds are in a great measure 
due to much altered semen, and that the brilliant points come from 
the seminal vesicles. 

Certain precautions are necessary in order to observe all the cha- 
racteristics of which I have spoken. In the first place each discharge 
of urine should be collected in a separate vessel, because the excre- 
tions passed at different parts of the day do not often present the 
same appearances. The morning urine generally contains most de- 
posit, especially when the night has been restless. Urine passed 
after moral or physical excitement of the genital organs also con- 
tains a large quantity, as well as that after a sudden chill, an at- 
tack of indigestion or violent emotion of any kind. Often the urine 
is perfectly transparent during a whole day, or several days, and 
the patients under these circumstances experience a remarkable 
improvement in their symptoms. 

This method of studying the urine permits us therefore to follow 
all the oscillations of the disease, and to appreciate those causes 
which act most energetically on each individual. Such causes may 
be very different, and even opposite to one another; thus, for in- 
stance, in one person, cold dry weather is injurious; in another, 
warm and moist. 

The vessels to receive the urine ought to be quite transparent. 
Round bottomed glasses like exaggerated and much deepened watch 
glasses are useful; but champagne glasses are more advantageous 
when the deposit is wanted for microscopic research. 

Other Diurnal Pollutions. — Certain other diurnal pollutions may 
occur, but in such cases there are generally involuntary discharges 
during defecation and the emission of urine, present at the same 
time. 

Such pollutions may take place during horse exercise, from the 
jolting of a carriage, the friction of the clothing, mental excitement, 
and in a few very rare cases without either moral or physical provo- 
cation. In the last cases the patients experience suddenly, while 
engaged in study, a pinching in the prostatic region, with a sense of 
spasmodic contraction between the bladder and rectum ; perhaps they 




LOCAL SYMPTOMS. 259 

get rid of these sensations by change of posture, pinching the skin, 
&c; but the discharge of semen takes place with the next emission 
of urine. I can only attribute these phenomena to some special irri- 
tation of the seminal vesicles, or of the nerves distributed to them. 

Impotence. — Loss of virility, when not attributable to any evident 
cause, must be considered a local symptom, and one of the most 
certain of involuntary seminal discharges. The effects of age, of 
serious diseases, and of lesions of the testicles are of course left out 
of the question in this statement: and there-are also other cases which 
must be carefully distinguished from habitual and acquired impotence. 

Under the influence of powerful moral impressions, of whatever 
kind, the genital organs may occasionally not respond to the most 
energetic desires. Sometimes even the violence of the excitement 
may prevent its external manifestation. But this condition passes 
off with its exciting causes, and the same individual under other 
circumstances regains his normal vigour. Such accidental occur- 
rences must, therefore, be distinguished from habitual impotence. 

In other cases too the evolution of the genital instinct never per- 
fectly takes place; some even never experience a commencing pu- 
berty. I once saw a man, thirty years of age, very fat, without beard 
or hair on the pubes, whose testicles and penis appeared to belong 
to a child of seven or eight years ; he had never experienced either 
erections or venereal desires. This case may be considered as the 
type of congenital impotence. It is rarely so complete, but in no 
case must it be confounded with the acquired condition. 

On the other hand again, acquired impotence presents different de- 
grees which are important. Some patients never have complete erec- 
tions, others only experience them accidentally, as for instance, at 
the moment of waking, or when the rectum or bladder is distended. 
But such erections never acquire the same degree of energy as 
normal ones. In other persons again the morbid sensibility of the 
organs is so great that emission takes place on the least contact, with- 
out perfect rigidity of the corpora cavernosa. In this case — the least 
serious and the most common of all — there is yet impotence, even 
although intromission be possible, because fecundation cannot be the 
result of so precipitate an act, by means of which the seminal fluid 
cannot pass into the neck of the uterus. These are cases of only 
commencing impotence, which may be as slight as possible; but 
when it has continued some little time we may be sure that involuntary 
discharges are present. Those involuntary discharges which take 
place during defecation and the emission of urine being the only 
ones of which the patient may not be aware, we may infer whenever 
any notable and permanent diminution of the genital functions oc- 
curs, that the patient suffers from diurnal pollutions. 

The presence of well formed semen in the seminal vesicles is the 
cause of all normal erections, and without this essential condition 
either direct or indirect excitement would have no action on the 
erectile tissues; habitual and acquired impotence, therefore, arises 



260 CAUSES OF SPERMATORRHEA. 



from the want of the normal stimulus in the vesicles, and is, conse- 
quently, one of the most certain signs of the presence of diurnal 
pollutions. 

I now proceed to consider the means by which the actual presence 
of semen in the urine, or under other circumstances, can be unequi- 
vocally demonstrated. 

Chemical Analysis. — The analysis of animal matters is too com- 
plicated a process and too uncertain in its results to permit of its 
employment by practical men in distinguishing semen from mucus 
or prostatic fluid. The use of warm water applied to stains on the 
linen in order to favour the evaporation of the odoriferous particles 
cannot strictly be considered a chemical process, and the odour of 
semen passes off too rapidly to allow of its being always ascertained 
by our obtuse olfactory organs. It is, therefore, a distinctive cha- 
racter of little importance, whatever acuteness the sense of smell 
may acquire from long habit. 

Microscopic Examination. — Since the discovery of the spermatozoa 
their presence in the seminal fluid has attracted the attention of all 
who have sought means of distinguishing it from other fluids. Micro- 
scopic examination of the spermatozoa, however, not only requires an 
excellent instrument, but certain precautions which maybe dispensed 
with in the investigation of coarser objects. As the spermatic ani- 
malcules can be only seen by means of transmitted light, it is neces- 
sary that the glass on which the fluid to be examined is placed should 
be of uniform thickness, and without bubbles or striae. The fluid to 
be examined should be covered by another layer of extremely thin 
glass made on purpose, and not by portions of mica, which are seldom 
free from cracks, and never perfectly transparent. This thin layer of 
glass is indispensable in order as much as possible to diminish the 
thickness of the fluid, to render it perfectly uniform, to hinder eva- 
poration and prevent the object glass from being soiled by it. A 
single drop of fluid suffices for a complete observation, a larger quan- 
tity always proving inconvenient. The little glass that covers the 
liquid must be firmly pressed down so as to spread it out, arrest the 
currents that take place in it, and drive out the air bubbles. Although 
the glasses should seem to touch each other, the spermatozoa move 
with perfect freedom in the space between them, so long as they 
preserve their energy and evaporation has not proceeded too far : 
should such be the case, however, a drop of tepid water favours and 
much prolongs their motions. However thin the layer of fluid may 
be, it is impossible to comprehend its whole thickness at once with a 
very high power, and it is, therefore, necessary to alter the focus 
frequently in order to be sure that nothing escapes observation. And 
this is especially important in examining a drop of fluid obtained from 
diurnal pollutions, because there are frequently only two or three 
spermatozoa contained in it. It is also necessary to change the posi- 
tion of the reflector frequently in order to vary the direction and 
intensity of the light. The spermatozoa are often exceedingly trans- 



Lai 



LOCAL SYMPTOMS. 261 

parent in cases of disease, and a very bright perpendicular light is by 
no means the best for showing them. Varying the density of the 
fluid under examination, either by adding water or by permitting 
evaporation, is also often useful. The semen contains matters 
furnished by the seminal vesicles, the prostate and the urethra, and 
when the fluid is too thick these matters hide the animalcules. A 
drop of water applied to the edge of the covering-glass penetrates 
underneath it, and the spermatozoa are more isolated, at the same 
time that their contour is rendered more defined by the diminution in 
density of the fluid. On the other band the refractive power of the 
spermatozoa differs little from that of the fluid in which they are con- 
tained, and their thinnest portions are traversed by the light without 
affording any distinct images to the eye. In this case there are only 
seen very small ovoid brilliant globules terminated by a little point. 
As soon as the water begins to penetrate between the glasses, the 
rapid motion set up prevents the objects from being clearly distin- 
guished; but as soon as rest has been re-established the tails of the 
animalcules appear, and their dimensions seem to have increased in 
consequence of the diminished density of the surrounding fluid: water 
suffices to produce this result. It is more sensible, however, when a 
small quantity of alcohol is added: but the forms of the animalcules 
are, after a time, altered by this agent ; and it is, therefore, advisable 
to use water only when it is intended to keep the preparation. 

Evaporation sometimes produces not less remarkable changes in 
the seminal fluid. I have frequently in cases of spermatorrhoea failed 
to perceive any thing in the fluid under examination for half an 
hour, an hour, or more ; then suddenly an animalcule has made its 
appearance ; then a dozen, and then perhaps a hundred in the space 
of a few minutes. The following morning, when desiccation has be- 
come complete, there are no longer any traces of these animalcules, 
or, at all events, I have been only able to distinguish their tails, 
the other parts of them being fixed in the dried up mucus. The 
absorption of a drop of water has restored the phenomena observed 
the night before. 

These phenomena are easily explained: when the refractive power 
of the spermatozoa is the same as that of the circumambient liquid, 
the light traverses the whole in the same manner, and the mass ap- 
pears homogeneous. But evaporation acts more rapidly on the liquid 
than on the organized bodies contained in it ; and when the difference 
of density alters the refractive power the forms of the spermatozoa 
are momentarily defined because they have become more transparent 
than the remainder of the fluid. When desiccation is complete, 
however, the animalcules again disappear, because the refractive 
powers of mucus and dried animalcules are again equal. The ap- 
sorption of a small quantity of water reproduces the same pheno- 
mena, which may be repeated almost indefinitely, since the matter 
confined between the two layers of glass undergoes no other appre- 
ciable alteration. 



262 SYMPTOMS OF SPEEM AT ORRH CE A 



In order to be enabled to discover spermatozoa quickly in cases 
of disease, it is necessary that they should be well studied in healthy 
cases. This may be accomplished in the following manner: — After 
coitus there always remains a sufficient quantity of seminal fluid in 
the urethra to serve for precise and complete microscopical exami- 
nation. This may be obtained by pressing the canal shortly after 
the act, and receiving the drop of fluid from the orifice of the glans 
on a plate of glass. In this drop of fluid thousands of animalcules 
may be seen, agitating themselves like so many tadpoles in a pool 
of stagnant water, only that the tails of the spermatozoa are relatively 
longer and thinner, and that the head presents a brilliant point near 
its insertion. Generally the number of these animalcules prevents 
them from being easily examined, and it becomes necessary to spread 
them out by introducing a small quantity of water, and pressing 
firmly down the thin glass that covers them ; they are found most 
separated on the edges of the fluid. If the water added be of the 
temperature of the body their motions become free and lively, and 
continue so until cooling and evaporation affect them. By avoiding 
these two causes of disturbance the motions of the spermatozoa may 
be kept up during several hours. 

However long a time may have elapsed after coitus there are al- 
ways spermatozoa in the urethra, provided they have not been washed 
away by the passage of urine. Although the point of the glans may 
be .quite dry, and pressure along the whole length of the canal 
may not produce the least dampness, still on passing urine living 
animalcules may be obtained from the first drop which escapes. 
This may be received on the glass, and is perhaps the easiest and 
most natural mode of obtaining spermatozoa from microscopic exa- 
mination. 

It is evident that the same experiments may be applied in the 
case of nocturnal pollutions as well as in all other seminal discharges 
in whatever manner they may occur. But many errors may arise 
from commencing with cases of disease, for it is during perfect 
health that the spermatozoa are most active, and their development 
most complete, and they live longer after coitus than after any other 
kind of seminal discharge. 

Having thus described the means by which my microscopic ob- 
servations may be verified, I proceed to show their results. 

Spermatozoa. — Out of thirty-three bodies which I have examined 
for spermatozoa, I only twice found these animalcules in the testicles. 
In one of these cases the patient died from the effects of a fall on the 
day following it ; in the other acute gastro-enteritis was the cause of 
death. The seminal fluid was most abundant, and contained the 
greatest number of animalcules in the former case. The other pa- 
tients died of chronic diseases after protracted sufferings. One only 
among them died on the second day of acute peritonitis, but he was 
seventy-three years of age. In thirty-one of these patients the tes- 
ticles were soft, pale, and as though withered. On section they pre- 



3es 



LOCAL SYMPTOMS. 263 

sented a grayish aspect, and did not furnish any liquid; the structure 
was almost dry, and contained few blood vessels ; the secreting 
canals were easily separated from one another, and could be spread 
out under the microscope without breaking. They presented very 
brilliant granules, all of exactly the same appearance, about the size 
of the head of a spermatozoon, ten times smaller than corpuscles of 
blood or mucus, and differing from the latter by the constancy and 
regularity of their form. These brilliant bodies which occupied the 
place of the spermatozoa, are worthy of notice, because they offer 
considerable analogy to the appearances presented by the semen 
under certain circumstances. 

In order to observe what is present in the secreting canals of the 
testicle it is necessary to spread out a portion of one of them under 
the microscope, after having examined it dry to allow a drop of 
water te penetrate between the two glasses, and to follow the changes 
which take place ; then to press down the glass so as to flatten the 
parietes of the canal, rupture it, and press out a portion of its con- 
tents ; lastly, these must be examined again when desiccation is 
complete, for the spermatozoa found in the canals are then best seen. 

In the epididymis I have never found spermatozoa, except in the 
two cases in which they were also found in the testicles. In all the 
others I met with these animalcules only in the vasa deferentia or 
seminal vesicles. There were no animalcules at all to be found in 
the patient who died at the age of seventy-three. It has always 
seemed to me that the animalcules were less numerous in proportion 
as the patients had suffered long ; and in extreme cases I have gene- 
rally found them only in the seminal vesicles. The fewer the sper- 
matozoa the more difficult were they of detection on account of their 
extreme transparency. In some cases I have only suddenly dis- 
covered them after examining for an hour or two, the liquid having 
previously appeared quite homogeneous. The dimensions were the 
same as those of the best developed animalcules, but they were pale 
throughout their whole extent, and more transparent than the sur- 
rounding fluid. Complete desiccation often caused them to disap- 
pear altogether; but the same phenomena could be reproduced by 
the absorption of a small quantity of water. 

In cases of phthisis, caries of the vertebrae, white swelling, &c, I 
have had great difficulty in distinguishing the animalcules, probably 
because these diseases do not cause death for a long time. 

I have almost always found in the seminal vesicles, especially at 
the bottom of any depressions, a thick, grumous brilliant matter, 
varying in its aspect and colour, but considerably resembling thick 
paste, and more or less transparent ; with a high power the granules 
of this matter appear large, irregular, more or less opaque, and with- 
out any constant shape. They are evidently the products of the in- 
ternal membrane of the vesicles, for they are found with similar 
characters in the accessory vesicles of the hedgehog, rat, &c, which 
never contain seminal animalcules, and do not communicate directly 



264 SYMPTOMS OF SPERMATORRHOEA. 

with the vasa deferentia, which, again, never contain any similar 
substance. This matter is, therefore, analogous to that secreted 
by the prostatic follicles, Cowper's glands, &c. Its functions are 
the same, and for many reasons it merits special attention. 

The secretion of semen diminishes in all serious diseases, and 
seminal evacuations become very rare, especially towards the last. 
It is not, therefore, astonishing that the products of the mucous mem- 
brane predominate in such patients over those of the testicles, and 
that such mucus should become more consistent during its long 
residence in the depressions of the vesicles. Hence, the difference 
observable between the semen obtained from the vesicles after death, 
and that which is passed by a healthy person. Nevertheless, after 
long-continued continence more or less large granules are often seen 
in the semen of a healthy person, and these are perfectly distinct 
from the fluid part. When the emissions are more frequent, gra- 
nules of the same kind may be observed, but much smaller. These 
facts are important when applied to explain several symptoms of 
diurnal pollutions. 

I have already stated'that on causing the patients to make water 
in a bath, the semen passed may be easily recognised by means of 
its globules which whirl about in the middle of the cloud formed to- 
wards the close of micturition. From what we have just seen it is 
evident that these globules come from the internal membrane o,f the 
seminal vesicles. They may be wanting in very severe cases where 
the semen has no time to acquire consistence; but their presence 
leaves no doubt as to the existence of diurnal pollutions, because 
they can only be furnished by the seminal vesicles. On the other 
hand, I have invariably found spermatozoa in the urine of patients 
who observed this phenomenon in the bath. The same remarks hold 
good when applied to the globules which the urine deposits in cer- 
tain cases of diurnal pollutions, and which have been compared by 
some to grains of bran, by others to millet seed, pearl barley, &c, 
according to their size. These globules are perceived as soon as the 
urine is passed; they are roundish, very soft, and do not give any 
sensation when squeezed between the finger and thumb; they can- 
not, therefore, be confounded with urinary salts which are deposited 
only when the urine has cooled, have a crystalline form, and give 
the sensation of a hard body to the finger. The vesical mucus also 
is only deposited on cooling, and does not furnish brilliant granules. 
As to pus, its appearance is easily determined. I have found animal- 
cules whenever these globules appeared in the urine; and hence it is 
that I have pointed them out as certain signs of diurnal pollutions. 

I have also noticed that in some cases the urine, when held against 
the light, presents in the middle of a flocculent cloud multitudes of 
quite characteristic brilliant points. These are smaller, and, conse- 
quently, lighter globules than those which in other patients fall to the 
bottom of the vessel. They are neither observed in the mucus of the 
bladder nor in the prostatic fluid, which alone present clouds analo- 






LOCAL SYMPTOMS. 265 

gous to those of diurnal pollutions. Such brilliant points also arise 
from the seminal vesicles, and their presence is, therefore, an indi- 
cation that the urine contains semen. This I have often verified with 
the microscope. I should, however, warn those who wish to repeat 
my experiments, that it is not in the midst of the flocculent cloud 
that the zoosperms are to be sought, but at the bottom of the vessel, 
to which they soon fall on account of their greater specific gravity. 
The results of all my observations on the dead subjects, therefore, 
convince me of the influence of serious and long continued diseases 
on the functions of the spermatic organs. But it is not only in the 
morbid state that these experience great variations ; remarkable dif- 
ferences may exist between healthy individuals not only in the quan- 
tity of semen secreted in a given time, but also in the number, 
appearance, and dimensions of the spermatozoa. In this respect I 
have observed differences amounting to a third, and, in some cases, 
to half. The comparison is very easily established. When the semen 
is kept under a thin glass, as I have before described, it is not in 
danger of undergoing any changes, and may be always, by the 
addition of a drop of water, compared with a recent specimen. 

Notwithstanding the facility with which nocturnal pollutions may 
be recognised, I have submitted the semen collected after them, by 
individuals in various conditions of health, to microscopic examina- 
tion. At first, when the evacuations are still rare, and the semen pre- 
serves its ordinary characteristics, the animalcules do not present 
any remarkable circumstance in regard to their number, dimensions, 
&c. ; but when the disease has reached a sufficient degree of gravity 
to affect the rest of the system, the semen becomes more liquid, and 
the spermatic animalcules less developed and less lively. Their 
number, however, does not as yet sensibly diminish ; indeed, in some 
cases it seems increased. As the disorder advances the erections 
diminish, the semen becomes more watery, and the animalcules are 
often a fourth or a third less than natural, and the tail is often dis- 
tinguished with difficulty under a power of three hundred diameters. 
At a still later period the animalcules become fewer, and in two 
individuals in the last stage of the affection the semen no longer 
contained animalcules, although it retained its characteristic smell. 
Examined with high powers and every proper precaution, I only found, 
in this semen, brilliant globules, all exactly alike, and about the 
same size as the head of a spermatozoon. 

The microscopic examinations which I have made of semen passed 
during efforts at stool give analogous results. When such discharges 
only take place accidentally and at long intervals, the semen is thick, 
whitish, impregnated with a powerful smell, and abundantly furnished 
with" well developed animalcules. I have sometimes even found a 
few alive after an hour or two. But when these discharges become 
so frequent or habitual as to constitute disease, they become less 
abundant and the semen loses its normal properties. The spermatozoa 



266 SYMPTOMS OP SPERMATORRHOEA 



ess 

i 



are generally smaller than in the healthy condition, and always less 
lively. I have some preparations in which they are only 
half the ordinary size, and I have never been able to find a single 
living animalcule a few T minutes after the fluid had been expelled. 
When the disease has become much aggravated the spermatozoa be- 
come rare, and they are sometimes replaced by ovoid or spherical 
globules similar to those of which I have already spoken. In three 
patients in an extreme state of disease I found nothing else, although 
they passed as much as a dessert spoonful of semen at each stool. 
Such cases, however, are exceedingly rare. 

In diurnal pollutions happening during the passage of urine the 
following means may be employed to show the presence of sperma- 
tozoa. 

The urine should first be filtered in a conical filter, when, on ac- 
count of their weight, the greater number of the spermatozoa will 
remain on the lowest part of the paper. By taking this portion and 
turning it upside down in a watch-glass containing a few drops of 
water, the animalcules become detached from the paper by degrees, 
and fall to the bottom of the fluid in the glass. After twenty-four 
hours' maceration in this position, the paper may be taken away and 
the spermatozoa may be readily obtained by using a drop from the 
bottom of the fluid in the watch-glass for examination. This mode 
of proceeding is a sure one, but it requires considerable time and 
trouble for its performance. I have already stated that the urine 
does not always contain spermatozoa in cases of diurnal pollutions ; 
therefore, the urine of the same individual would perhaps require 
examination on many occasions before the certainty of their presence 
could be established, and few medical men in active practice have 
time to devote to such experiments. I for one should have long 
since given up treating these patients had I been obliged to repeat in 
every case such long and tiresome examinations. Ten days or a fort- 
night are sometimes passed without the appearance of spermatozoa 
in the urine, and hence all who are accustomed to microscopic re- 
searches will admit the indefinite amount of trouble and time required. 

Fortunately, however, there is a more simple method by which 
such examinations may be conducted. It will be recollected that the 
semen always escapes either with the last drops of urine, or imme- 
diately, or soon afterwards. By directing the patient, therefore, to 
compress the urethra immediately after micturating, and to receive 
the drop of fluid pressed out on a piece of glass, sufficient animalcules 
will be obtained from the walls of the urethra for microscopic obser- 
vation. These being covered with a thin lamella of glass may be 
either at once placed under the microscope, or may be allowed to 
dry, and examined at a future time, a drop of water being previously 
added. This mode of examination is, therefore, easy for all practi- 
tioners who possess a good microscope, after they have accustomed 
themselves to the inspection of the spermatozoa in their natural state. 



LOCAL SYMPTOMS. 267 

The changes which I have mentioned as occurring in the semen must 
be borne in mind, however, and the animalcules must not be expected 
to appear either so large, so well defined, or so numerous as in cases 
where there is no disease. 

Some interesting microscopic researches have been made on the 
stains of semen appearing on linen, but as these are too complicated 
for ordinary cases, and are chiefly of use in medico-legal investiga- 
tions, I need not give any account of them here, 



263 SYMPTOMS OF SPERMATORRHEA 






CHAPTER XII. 

SYMPTOMS OF S PERM AT ORRH OS A . 

General Symptoms. 

Infeeundity . — Impotency is an absolute cause of infecundity, be- 
cause it prevents the conditions necessary to fecundation from taking 
place ; but although the act of coitus may be accomplished, it does 
not follow that the person should always be able to perpetuate his 
species. Stricture of the urethra may prove an obstacle to the dis- 
charge of seminal fluid ; or the fluid may be directed towards the 
bladder or the parietes of the urethra, by deviation of the orifices 
of the ejaculatory ducts. The secretion may be altered in its nature, 
it may only contain imperfect spermatozoa, &c. A man may, there- 
fore, be unfruitful without being impotent. On the other hand, I 
have met with many patients suffering from diurnal pollutions who 
had children exactly resembling them, even during the duration of 
their disease. Indeed, I have seen several cases in which the dispo- 
sition to involuntary discharges was hereditary, and they affected 
both father and son. The disease is, however, essentially irregular 
in its progress ; it may continue long without doing serious injury 
to the health; long remissions may be experienced, or even a perfect 
cessation of the complaint for a longer or shorter time ; we may 
easily conceive, therefore, that in the first degree, or during one of 
the periods of remission, fecundation may take place. When the 
disease is further advanced, however, many causes concur to render 
coitus unfruitful. Ejaculation is weak and precipitate, so that the 
seminal fluid cannot be thrown into the cavity of the uterus; it is 
not sufficient, in order to fecundate, simply to spread the fluid over 
the vagina; it must be projected with sufficient force to pass through 
the orifice of the uterine neck. Besides, in these cases the erec- 
tions, even when they permit sexual intercourse, are incomplete and 
of very short duration ; emission takes place without energy and very 
soon; so that during such rapid acts the uterus and Fallopian tubes 
have not sufficient time for their office : the semen itself undergoes 
great changes, to which perhaps the loss of the fecundating power is 
chiefly attributable. Microscopic researches have elucidated this 
formerly obscure subject; I have discovered, for instance, that the 



GENERAL SYMPTOMS. 269 

spermatozoa undergo changes similar to those of the fluid which; 
serves as their vehicle ; these changes are exceedingly important, 
and are owing to defective formation. Spermatozoa may be met 
with in a less thick and less opaque fluid than natural, for they are 
not produced by the same parts, or in the same manner ; but when 
the secretion is perfectly thin and watery, the functions are so seri- 
ously affected that the animalcules are altered ; they are less de- 
veloped, less opaque, and less active than natural ; indeed, they are 
so transparent that peculiar precautions are necessary in order to 
make sure of seeing them ; their motions are weak, slow, and cease 
very soon; and they rapidly undergo decomposition. All these cha- 
racteristics show how much their texture is relaxed, and how imper- 
fectly they are organized. 

It is evident that the least arrest of development in the sperma- 
tozoa must prove an insurmountable obstacle to fecundation, even if 
the only function of the animalcules be to carry the liquor seminis 
to the ovum. When, however, their imperfect development only 
arises from a too rapid formation it may soon be obviated. It suf- 
fices that the involuntary discharges should cease for a few days only, 
in consequence of some accidental cause, or of one of the spontaneous 
changes of this extraordinary disease, in order for the desires to be- 
come more lively, the erections more energetic and prolonged, and 
for the function to be accomplished in a natural manner. Fecunda- 
tion is, therefore, possible, as I have previously stated, during the 
whole duration of one of these intermissions. 

This is not the case when the spermatozoa are malformed, rudi- 
mentary, more or less deprived of tail, &c, for these changes only 
take place when there is a serious alteration in the structure of the 
testicles. I have taken every opportunity of dissecting the testicles 
altered in these cases, and I. have always found the secreting struc- 
tures paler, drier, and denser than natural, and the cellular tissue 
more resisting, and with difficulty allowing the secreting ducts to be 
separated one from another. Sometimes half or two-thirds of the 
testicle were transformed into a fibrous or fibro-cartilaginous tissue, 
mixed in a few cases with tuberculous matter, to experience the ex- 
citement necessary to carry the semen to its destination even when 
it passes the neck of the uterus. Nor is it especially in the epididy- 
mis. I have even seen traces of ossific deposit in the midst of cartila- 
ginous indurations. These changes, caused by previous inflamma- 
tion, perfectly explain why the development of the spermatozoa can 
no longer proceed, normally. 

Although in such cases the secretion of semen may be more or less 
diminished, pollutions may still be present if the seminal vesicles 
have shared the inflammation by which the testicles have been affected, 
as happens in most cases of orchitis arising from blennorrhagia. I 
have at present a patient who presents a remarkable example of both 
these effects arising from this cause : he is now forty-one years of 
age, and had blennorrhagia followed by inflammation of both testi- 



270 SYMPTOMS OF SPERMATORRHEA. 

cles at twenty-five. Soon after his recovery, he married, but has 
never had children, although the act has been performed regularly if 
not frequently. He became subject to nocturnal, and sometimes diur- 
nal pollutions, which increased by degrees. His health became dis- 
ordered, but coitus was still possible. The semen passed, although 
it presented its characteristic odour, never showed under' the micro- 
scope other than very small and brilliant globules without any appear- 
ance of tail, but easily distinguishable from globules of mucus, the' 
dimensions of which are five or six times larger. The epididymis of 
both sides is voluminous and irregular. One testicle is adherent to 
the skin of the scrotum, and the other appears smaller than natural. 

Malformation of the spermatozoa, therefore, arises from deep- 
seated changes in the tissues of the testicles, changes which do not 
permit the animalcules to resume their normal form, and, therefore, 
render infecundity permanent. 

To sum up, then. Involuntary seminal discharges may oppose fe- 
cundation previously to actually producing impotence, by diminish- 
ing the energy of all the phenomena that concur to the accomplish- 
ment of the act, and by preventing the complete development of the 
spermatozoa, as well as the elaboration of the fluid which acts as the 
vehicle for them. 

These conditions may be rapidly altered by the simple diminution 
of the involuntary discharges, and fecundation may again become 
possible. 

This cannot be the case when infecundity depends on malforma- 
tion of the spermatozoa — such malformation arising from permanent 
alteration in the organs that supply them. 

Fever. — Whatever may be its characters, fever can never be con- 
sidered as a symptom of involuntary seminal discharges — such eva- 
cuations, however serious they may be, never producing febrile ex- 
citement. Patients suffering from spermatorrhoea, however, are not 
exempt from fevers arising from other causes; indeed, they become 
more liable in consequence of their constitutions resisting such 
causes less directly. These fevers must, therefore, be considered 
as accidental complications, and treated as such. 

Symptoms affecting the Digestive Organs. — At first venereal ex- 
cesses are generally accompanied with an increased appetite from 
the necessity the economy experiences of making up its daily losses, 
and from the excitement of the genital organs. Masturbation often 
produces analogous effects ; sometimes, too, voracity or boulimia re- 
sults from it. 

After a longer or shorter time, according to the power of the sto- 
mach, the patient's digestion becomes less easy, and after a time very 
laborious. In this condition, if the excesses or abuses cease, the 
disorder of the digestive organs is soon repaired, and all again be- 
comes natural. This cannot take place when once involuntary dis- 
charges have supefvened. 

Still the patients continue to eat as usual, or even more than usual, 
either because they wish to repair their strength by abundant and 



GENERAL SYMPTOMS. 271 

succulent food, or because they feel a real appetite. The sensation 
experienced in the latter case is not precisely that of common hunger ; 
it is rather a sense of gnawing and heat referred to the epigastrium, 
or a kind of uneasiness or sinking which sometimes nearly causes 
faintness. A small quantity of food puts an end to this sensation, 
and soon afterwards disgust is felt. But the patients compel them- 
selves to eat against their will, or they increase the number of their 
meals in proportion as the uneasiness in the stomach becomes more 
frequently repeated. By some means or other they generally take 
during the twenty-four hours more food than their stomachs are able 
to digest. 

Almost all, too, seek the most spiced and most savoury kinds of 
food and take alcoholic drinks, coffee, &c, in order to favour the di- 
gestive process. But these dangerous auxiliaries cannot restore the 
original vigour to their digestive organs ; they only beget excitement, 
not healthy strength. Hence, the illusions produced by this stimu- 
lating diet are not of long duration. Those who expected the greatest 
benefit soon find their digestion more difficult and painful; they have 
thus increased the irritation of the stomach. 

A constant and remarkable increase in the involuntary discharges 
results as much from the effects such excitants produce on the whole 
economy, as from the special influence of the stomach on the sper- 
matic organs, for there is a reciprocal action as usual. 

In perfect health, excitement of the genital organs is soon followed 
by increased appetite; and, on the other hand, a succulent meal 
disposes to coitus long before any increased secretion of semen can 
result from it. The same relations exist when the functions are dis- 
ordered; for, if abundant involuntary discharges provoke painful 
sensations in the stomach, attacks of indigestion equally increase 
these involuntary discharges. I have related a case in which three 
relapses occurred during convalescence from spermatorrhoea, simply 
from attacks of indigestion. 

Various phenomena of considerable importance accompany these 
indigestions. The meal is not followed by that vague sense of 
comfort which attends reparation of the economy ; on the contrary, 
a sense of weight is felt in the epigastrium, and produces a degree of 
uneasiness and of restlessness which induces the patient to change 
his position : the pulse is quickened, and sometimes beats violently ; 
the face flushed; confusion of ideas follows, with noise in the ears 
and vertigo ; and sometimes symptoms of cerebral congestion which 
may proceed so far as to induce a fear of apoplexy. 

An increasing degree of torpidity succeeds this excitement in pro- 
portion as the disorder of the stomach becomes more fatiguing ; hence 
the tendency to inactivity and sighing. Besides which, acid eructa- 
tions, and an acrid burning heat at the top of the oesophagus with a 
species of pyrosis sufficiently point out how disordered is the diges- 
tive process. 

When this badly formed chyme passes into the duodenum, it pro- 



272 SYMPTOMS OF SPERMATORRHEA. 

duces abnormal impressions which are transmitted to the liver and 
]3ancreas by their excretory ducts ; hence the secretions of these glands 
are altered. The digestive process carried on in the small intestine 
is thus still more deranged than that in the stomach; hence arises 
evolution of flatus, with its accompaniments, colic, griping, &c. 
After causing borborygmi the flatus becomes collected in the stomach 
and large intestines from their greater size, and distends them fully 
on account of the laxity of their muscular coats. Frequently local 
spasmodic contractions, however, oppose the passage of the flatus, 
and these are produced by the irritation of the mucous membrane. 
The distention is most marked in the epigastric and hypochondriac 
regions, from the stomach and colon being situated in those localities. 
Hence, the pressure on the diaphragm and the difficulty of breathing, 
as well as the constant uneasiness which exists in the parts until 
the flatus has been expelled. Hence the necessity which the patients 
feel of passing the flatus as soon as possible, and the disorders to 
which they are subject when any circumstances compel them to op- 
pose this desire. 

The dislike such patients manifest for society is also explained by 
this circumstance. They feel the necessity of being alone after their 
meals, in order to be perfectly free to expel the flatus without shame. 

Independently too of these daily inconveniences, such patients are 
occasionally exposed to very severe attacks of colic. After a con- 
siderable collection of flatus in the intestines, a kind of cramp seizes 
on the cardiac and pyloric extremities of the stomach and the ileo- 
csecal valve, or on some other part of the intestine, and prevents any 
passage just as much as internal strangulation. The distention in- 
creases rapidly, and with it local pain and difficulty of breathing. 
The heart's action becomes rapid and irregular ; the patients throw 
off their clothes; the least pressure on the abdomen is insupportable; 
they feel as though their bowels were torn or dragged ; abundant 
perspiration covers their faces, and indeed their whole bodies. In 
the midst of this torture, however, a low grumbling shows that the 
.flatus is making a passage, the spasmodic contraction becoming re- 
laxed. The pain passes off by degrees, and the attack generally 
ends in the expulsion of large quantities of flatus. 

When such violent attacks only continue an hour or so, no bad 
effects remain; but when the attacks are of longer duration they are 
followed by general debility during several days, with a yellowish 
skin and more marked derangement of the stomach, with a notable 
increase in the diurnal pollutions. 

It is self-evident that the frequent return of these colics must affect 
the whole system. Thus the patients dread what they call their 
"crises" or "attacks;" and as they are attributable sometimes to 
cold and sometimes to the effects of moral emotion, the patients are 
careful to avoid these causes. Hence their lives are passed in a 
series of trifling cares, of which their friends cannot understand the 
necessity. 



GENERAL SYMPTOMS. 273 

Sometimes too such patients suffer from spasms of the oesophagus, 
■which suddenly prevent deglutition, especially when very hot or very 
cohl drinks are taken. A complete obstacle is thus sometimes put 
to the passage of any matter, fluid or solid, during several minutes, 
just as though a knot had been tied in the oesophagus, and gene- 
rally at its cardiac extremity. 

There is not only, therefore, diminution of the digestive powers, 
but they are at the same time disordered. The organs are not only 
weaker, they are also more easily deranged. The symptoms vary 
much in different individuals, and in the same individual on diffe- 
rent days. Notwithstanding the patient's endeavours to discover 
the causes of these variations, the most important one generally 
escapes them; for it is almost always the occurrence of a diurnal 
pollution that increases their digestive disorder, and suddenly alters 
their characters and conduct. 

At length the more intelligent of these patients perceive that they 
eat too much; that certain kinds of food and drink do not suit them ; 
and by degrees, they impose on themselves a more and more severe 
regimen. They begin by giving up food of high flavour, such as 
game, &c. ; then nourishing food, as meat; afterwards lighter kinds, 
as vegetables; and at length they become reduced to a milk diet 
only. As regards fluids: at first they renounce spirits, coffee, and 
tea; afterwards wine; and at length are reduced to drink water. I 
have met with several patients who only took gum, milk, and sugar, 
and one of these had lived on such food two years when he con- 
sulted me. By this rigorous self-denial they escape the indiges- 
tion, &c, which too nutritive food produces in them, but they are 
exposed to a sense of sinking in the stomach, brought on frequently 
by hunger, and they are also frequently annoyed by flatus. In these 
cases it is no longer during the progress of digestion that the flatus 
is developed, but, on the contrary, after the stomach has continued 
a long time empty. The ingestion of a small quantity of food soon 
relieves. 

Other not less important changes take place at the lower extremity 
of the digestive canal. Incomplete digestion brings to the intestines 
badly formed chyme, which acts irritatingly on the mucous surfaces, 
and increases their secretion, and hence arise liquid and unnatural 
stools — a kind of transient diarrhoea which returns with every slight 
imprudence. The diarrhoea increasing on each occasion may be- 
come permanently established, and after a time present the ordinary 
chronic symptoms. MM. Fournier and Begin 1 state that they have 
seen the same result from excessive masturbation. 

Diarrhoea kept up by ulcerations in the intestines becomes alto- 
gether an idiopathic disease, the indications of which are peculiar 
and proportionally urgent, because the inflammation of the rectum 



1 Dictionnaire des Sciences MMicales. Art. Masturbation. 

18 



274 SYMPTOMS OF SPERMATOREHffiA. 

increases the diurnal pollutions by its action on the seminal vesi- 
cles : hence two debilitating diseases arise and rapidly increase the 
wasting of the body. But such cases are rare, and are only no- 
ticed in persons who do not check their voracious appetites. These 
are few. 

After numerous alternations of irritability and sluggishness of the 
intestines, constipation becomes permanently established, and grows 
more and more obstinate; or, at all events, only ceases for short 
periods to give place to diarrhoea after some error of diet. Con- 
stipation, therefore, almost always attends old cases of involuntary 
seminal discharge, and contributes to maintain the pollutions. 

The influence of this constipation is still more injurious than that 
of the stomach disorder, and hence the patients soon discover that 
there is a constant relation between the act of defecation and all they 
suifer from. They are perfectly aware that with soft, easy, and re- 
gular stools their strength returns, and their activity increases, their 
sensations are more lively, and their ideas clearer. Experience 
soon shows them the bad effects of long constipation : they are de- 
bilitated after laborious attempts at defecation. They are, however, 
for the most part ignorant that abundant diurnal pollutions result, 
although the constant repetition of the same phenomena at length 
fixes their attention on the importance of defecation, and that func- 
tion absorbs all their attention. Hence they are constantly occupied 
in seeking laxative food, slightly aperient medicines, enemata, &c, 
and frequently speak of these things from habit, and without consi- 
dering the effects of such conversation on others. The further we 
advance, then, the more we find that these general symptoms of in- 
voluntary seminal discharges are those which have been generally 
described as hypochondriasis. It is evident also, that, according to 
the predominance of certain symptoms, our profession have usually 
been in the habit of diagnosing pyrosis, disorder of the liver, ner- 
vousness, chronic gastritis, or gastro-enteritis, &c, in these cases. 
There is considerable correctness in these diagnoses; but the futi- 
lity of the treatment shows that the cause is very frequently unascer- 
tained. 

Nutrition. — The whole economy necessarily soon feels the effects 
of serious digestive disorder; for the condition most essential to 
nutrition is good digestion. The phenomena which follow meals in 
such cases show clearly enough that digestion is incomplete ; absorp- 
tion can, therefore, obtain only little reparative matter from a mix- 
ture of useless or even injurious material ; hence the structures of the 
body necessarily lose substance, and the functions languish. Not 
only does the embonpoint diminish, but also the energy and activity 
of all the organs; for it is necessary that all, in order to act well, 
should constantly receive a supply of rich blood. 

Still, however, it is far from an invariable rule that patients suffering 
from involuntary seminal discharges should be emaciated, or that they 
should all have a yellow or leaden appearance, or sunken hollow eyes. 



GENERAL SYMPTOMS. 275 

Many even preserve their embonpoint, fresh colour and healthful ap- 
pearance, although they may be impotent, weak and troubled with 
considerable disorders; and although they may even contemplate 
suicide. These are the patients who are considered as malades ima- 
ginaires, whose friends wish to marry them against their will, in order 
to draw them out of their isolation and melancholy. The constant 
persecution of their friends and relations increases the unhappiness 
of such patients by recalling to their recollection the bitter truth which 
they are unwilling to confess. Often have I heard these patients 
complain — "0 that I were thin and yellow, that I had the appear- 
ance of a sick person, I should then be pitied and permitted to follow 
my own inclinations." 

Whence arise such apparent anomalies? from congenital predis- 
position. The digestive organs of some individuals are sufficiently 
strong to resist the influence of involuntary discharges, which, on the 
other hand, seriously disorder all their other functions. There are 
others again whose assimilative powers are so active that the strictest 
diet is necessary in order to prevent extreme corpulency ; others too 
who are of marked sanguineous temperament never lose the redness 
of their cheeks and the size of their muscles. 

Animal Seat. — As soon as the digestion becomes deranged and 
the embonpoint decreases, the patients become more sensible to the 
influence of cold. They soon find that they must clothe themselves 
more warmly, keep out of draughts, and use increased precautions of 
every kind, in order to prevent pains in the limbs, catarrhal affec- 
tions, &c. But being very warmly clothed they are unable to take 
any active exercise without being covered with perspiration, which 
comes on very rapidly. On the other hand again, warmth during 
the night exposes them to the occurrence of pollutions. They are, 
therefore, continually endeavouring to reconcile these difficulties, and 
the importance they attach to trifling circumstances appears ridiculous 
to an uninterested spectator. 

It is evident then that the weakening of the body and its incom- 
plete repair, by means of badly formed matter, renders such patients 
more easily affected by the action of external agencies. Being de- 
bilitated they are more exposed to disease than other people, and 
the complaints that affect them are less quickly cured, and indeed, 
often pass into a chronic state. 

To the diminution of the nutritive powers must be attributed the 
early loss of hair which many of such patients experience, and which 
equally follows all diseases capable of producing serious disorder of 
the economy. 

The voice too is much affected by every prolonged action capable 
of debilitating the economy; and it is not, therefore, remarkable that 
it should often lose its power and quality of tone in these patients. 
But the voice is not only low and husky ; it presents a degree of 
uncertainty of tone which doubtless arises from the agitation the 



276 SYMPTOMS OF SPERMATORRHEA. 

patients constantly experience. The least emotion too makes them 
stammer. 

Respiration. — Not only while running or ascending a hill or stairs, 
but even on taking very slight exercise, patients affected with sper- 
matorrhoea become out of breath: sometimes, even, they feel op- 
pressed breathing during absolute quiescence ; they frequently sigh 
also. These symptoms, however, . are by no means always well 
marked. The same thing occurs with regard to the respiratory as 
in all the other systems. Variations take place in accordance with 
the constitution of the individual. These phenomena are produced 
in the following manner: — 

The muscles which perform the function of respiration, participating 
in the general debility of the system, contract less energetically and 
less frequently than natural; the respirations, therefore, become 
shorter and less frequent: hence the necessary changes in the blood 
are not properly performed, and there is defective equilibrium be- 
tween the respiration and circulation, with habitual sense of uneasi- 
ness and oppression in the chest. Hence arises the necessity for 
deep voluntary inspirations or sighs, to re-establish this equilibrium 
occasionally, and to fill the extreme pulmonary vesicles with air. 
The patients are apt to call these sighs involuntary, because they are 
forced to make them without knowing why. On the other hand 
again, being deeply afflicted at their condition, and incessantly occu- 
pied in seeking its cause, the patients sometimes suspend the motions 
of the thorax, and this habit increases their habitual oppression. 
Lastly, it is necessary to take into account the influence of the pul- 
monic nervous system. It is not probable that the pulmonary nerves 
should escape the generally debilitating influence of involuntary dis- 
charges. Dr. Deslandes indeed thinks that the nervous asthma may 
be produced by masturbation and venereal excesses, inasmuch as 
these attacks only seem to him to be aggravations of their ordinary 
symptoms. This opinion is strongly supported by what I have seen 
in many patients. The effects of exercise are the same in these as in 
all other cases of extreme debility. 

Patients suffering from spermatorrhoea often experience other symp- 
toms of which it is necessary to be aware. Sometimes they have a 
predisposition to pulmonary catarrh, with coryza, loss of voice, &c. ; 
in other cases there is a constant dry cough ; in others again, fixed or 
wandering pains in the thorax; and in a few cases a sudden pain 
seizes on the heart or diaphragm, and for a minute or two causes 
great agony. Most of the patients whose respiratory apparatus is 
thus disordered believe themselves the subjects of phthisis. The 
symptoms, however, only differ in situation from the other numerous 
irritations and pains which successively attack all parts of their 
bodies. 

Circulation. — The disorders of the circulating system in these cases 
may give rise to errors of much importance. I have seen more than 






GENERAL SYMPTOMS. 277 

thirty of these patients who had been long treated for disease of the 
heart of which there did not exist the least traces. The symptoms 
which had increased after every bleeding disappeared as soon as the 
involuntary .discharges were arrested. It is indisputable that abuse, 
venereal excesses, and involuntary discharges often excite more or 
less alarming palpitations ; but can we attribute the origin of organic 
diseases of the heart to such causes ? 

Even when an organic lesion of the heart or large vessels does 
occur in a patient who has practised masturbation, or committed 
venereal excesses, is it necessary that the disease be referred to these 
causes alone? Certainly not: for among the immense number of 
those who are exposed to the debilitating action of these causes it is 
unreasonable to expect that none should be found with cardiac dis- 
ease. I admit, however, that the momentarily increased rapidity of 
the circulation may aggravate organic diseases already existing; but 
certainly the diseases themselves would be much more frequent if 
they could be brought on by such common causes. 

The functional derangement of the circulation is, however, some- 
times so alarming and long continued that it may be easily mistaken 
for an idiopathic disease ; but these symptoms are more common in 
children than in adults, and in adults than in persons of mature age 
— a circumstance which alone is sufficient to show that the symptoms 
do not arise from organic lesion of the heart or large vessels. The 
same remarks apply to involuntary seminal discharges. 

Five of my patients had never committed any abuse or remarkable 
excess. One of them fell into the sea in very cold weather ; another 
was exposed to cold in helping to extinguish a fire ; a third had used 
constant horse exercise; and the two others had only suffered from 
blenorrhagia, yet all five experienced such palpitations of the heart 
that their attendants had not doubted the existence of an organic 
lesion. This palpitation, however, was purely nervous, and could 
not even be attributed to the perturbation of the circulatory system 
during voluntary seminal discharges. 

It is to the debility and disorder of the system, and especially to 
the disorder of the nervous system, that these symptoms must be re- 
ferred. As a proof of this there is the fact that they may be produced 
by any other debilitating causes; whilst they are never observed in 
robust individuals who take even the most violent exercise. 

It may be supposed that nervous palpitations would be distin- 
guished with difficulty from organic diseases of the heart: such is 
not the case, however. In organic diseases of the heart the face is 
habitually injected, the lips and tongue are violet-coloured from the 
obstruction to the venous circulation. Nothing similar occurs in 
nervous palpitation. If the cheeks become injected occasionally, they 
are red, and the injection soon passes off, the face resuming its na- 
tural tint afterwards. In either hypertrophy or dilatation the pul- 
sations are always proportioned in strength and frequency to the 
motions of the patient, because the obstruction to the circulation, 



278 SYMPTOMS OF S PERM ATO RRH <E A . 

whatever may be its seat or nature, is permanent ; whilst the quantity 
of blood driven towards the heart increases in proportion to the 
muscular efforts. The primary cause of such palpitations being 
therefore in constant action, the secondary one must always produce 
effects in proportion to its intensity. 

Nervous palpitations are far from following the same course. It 
is true that the least motion often increases them to an alarming 
extent, but this is by no means either constant or in proportion to 
the muscular efforts. At one time active and long continued exer- 
cise may produce no more effects than in a healthy individual ; whilst 
at another, sudden and violent disorder may come on, even when 
the body is in a state of repose, either from the sight of an unex- 
pected object, from a sudden noise, or from the passage through the 
mind of an involuntary idea. 

We see, therefore, that a superficial examination is sufficient to 
point out the difference between organic and functional diseases of 
the heart. Physical exploration is of course more certain. 

INNERVATION. 

Motility. — The weakness of patients suffering from involuntary 
seminal discharges does not arise from their loss of flesh only. Many 
of them possess embonpoint, healthy appearance, and even volumi- 
nous muscles, although quite unable to bear active and prolonged 
exercise. Debility always precedes the loss of flesh: it is invariable 
and marked; but at the same time disappears very quickly. When 
the patients have passed a few days in succession, without suffering 
from pollutions, they manifest rapid increase of strength and activity: 
a single discharge again reducing them to their debilitated condition. 
The weakness of their muscles, therefore, depends on a cause dis- 
tinct from atrophy; it arises from flaccidity. Let us consider how 
this weakness is produced. 

Masturbation is generally commenced before puberty, and the 
female sex is not exempt from it. In these cases, therefore, seminal 
emission cannot occur. Nevertheless, functional disorders of the 
spinal cord may arise, similar to those produced by passive discharges. 

I have related at page 153 the case of a boy, eight years of age, 
whose lower extremities were bent and drawn together, and in a state 
of paralysis, or rather of contraction, which prevented their use. 
This state ceased entirely a few days after masturbation had been 
completely prevented, the cure not being assisted by any other ex- 
ternal or internal treatment. I have met with several such cases in 
children before the age of puberty, and I should add that in most of 
them the arms were pressed against the body, the forearms bent on 
the arms and crossed on the breast, the fingers stiff, &c. 

On the other hand again, I have seen patients from thirty to forty- 
five years of age who had fallen into a similar condition from diurnal 
pollutions. Almost all had had leeches, cupping glasses, and issues 



GENERAL SYMPTOMS. 279 

not only on the loins but along the whole length of the vertebral 
column : all had found bad results from these means ; whilst the ces- 
sation of seminal discharges was immediately followed by free use of 
the extremities. 

The most passive pollutions act, therefore, on the nervous system, 
just as the most convulsive voluptuous sensations not followed by 
seminal emission; and the disordered powers of the lower extremities 
no more depend on the existence of organic disease of the spinal 
cord, than palpitations depend on organic disease of the heart. 
There are, however, many intermediate shades between this extreme 
condition and ordinary cases. On the other hand, there is not only 
muscular debility in such extreme cases, there are also stiffness and 
involuntary contraction of the muscles. It is not only in the lower 
extremities, too, that the symptoms are manifested, but throughout the 
whole muscular system. 

In many cases, there is more irregularity and disorder than actual 
weakness in the muscular system, and hence many such patients suffer 
from involuntary trembling and uncertainty, with a loss of precision 
in their motions that renders them awkward. Any slightly continued 
action induces trembling, to control which they have no power. 
These tremblings resemble the mercurial palsy of gilders, or the deli- 
rium tremens of drunkards. Hence many authors believe with rea- 
son, that masturbation and venereal excesses are two of the most fre- 
quent causes of chorea. Epilepsy even, may be induced — the same 
phenomena becoming more violent but less continuous. Epilepsy is 
brought on much more frequently by masturbation than by venereal 
excesses, probably for the following reason. Veneral excesses gene- 
rally take place later in life than masturbation, consequently the consti- 
tution is stronger. Cases of epilepsy, too, are more frequent after mas- 
turbation, in proportion to the youth of the parties. The same thing 
holds good with regard to all the other nervous symptoms produced 
by masturbation, and indeed, with all nervous symptoms, whatever 
may have been their cause. Here we again see the great importance 
of taking the state of the system into consideration in all these cases, 
in order to appreciate the different results that may arise. 

Sensation. — There are other nervous symptoms which seem the 
counterpart of those happening in the muscular system. I have met 
with two patients in whom the hands were insensible, and the hands 
only: in these cases, accidental burns took place without causing 
pain ; but the motions were perfectly free. Other patients that I have 
seen, experienced a diminution of touch only ; a layer of gauze seem- 
ing to be interposed between the object and the ringers. In other 
cases, one side of the chest or abdomen was more or less deprived of 
sensation ; or perhaps a circumscribed portion of the skin either on 
the trunk or extremities. This anesthesia changes its position and 
character frequently — quite enough to show that it does not arise 
from any organic lesion of the spinal cord or nerves. Other patients 
experience disorders of sensation, varying greatly in their character 



280 SYMPTOMS OF SPERMATORRHEA. 

and seat, not only in different individuals, but in the same person at 
different times. Sometimes there is a sensation of local heat or 
burning ; at others, a kind of current which seems as if caused by the 
air, by water, or by electricity ; or there may be a feeling of bruises, 
cold, or pressure, affecting the back and loins. 

Hippocrates described another sensation which I expected to find 
very frequently. I allude to the feeling of ants running along the 
vertebral column. I expected to find this symptom very common in 
cases of spermatorrhoea, but I have hardly met with it in one case 
out of twenty. Nervous pains, often confounded with wandering 
rheumatism on account of their uncertain seat, are met with much 
more frequently. They differ from rheumatism in not being caused 
by cold or damp, and in not being especially seated in the joints. 
The patients generally suffer most from these pains on rising in the 
morning. They generally follow the course of a nerve, and some- 
times resemble electric shocks. These characteristics are sufficient 
to distinguish such pains from rheumatism. 

The loins are especially the seat of these pains. They are not so 
acute as those that arise from lumbago or a violent muscular effort, 
but they continue longer. Some of my patients had been teased by 
them for many years, almost continuously. Their seat is not in the 
muscles, for the motions of the spinal column are not affected; they 
are not caused by the kidneys, for they do not pass in the course of 
the ureters — the testicles are not retracted, and the urine is not 
purulent — symptoms by which affections, of the kidneys accompanying 
spermatorrhoea may be easily distinguished. It seems therefore, that 
these pains must be especially referred to the nerves supplying the 
lumbar region. 

It is difficult to doubt the existence of a special sympathy between 
the genital organs and the spinal cord, when we take into considera- 
tion the influence of flagellation, urtication, &c, applied on the loins ; 
the frequent nocturnal pollutions excited by heat of this region and 
the opposite effects of cold. On the other hand again, this influence 
is reciprocal, for it is after abundant pollutions that the pains in ques- 
tion occur or increase, and it is of this region that patients complain, 
who have committed excessive abuse or venereal intercourse, or who 
have suffered several pollutions in one night. 

SENSES. 

Taste. — The changes experienced by these patients in the organs 
of taste correspond with those that are going on in the digestive 
organs. In some the appetite is disordered from the first, and when 
the disease has made considerable progress, the mouth is often clammy 
with a bitter, salt, or earthy taste. Food and drink appear less 
sapid, and do not give any agreeable sensation. Under these cir- 
cumstances the patients generally restrict themselves spontaneously 
to a vegetable diet, or even to milk. 



GENERAL SYMPTOMS. 281 

Smell. — I have paid little attention to the alterations of this func- 
tion in these patients; but I have heard many complain of a notable 
change in their power of appreciating odours and even of an entire 
loss of the sense of smell. 

Hearing. — The sense of hearing suffers more changes than the 
preceding. In general, like the others, it loses its acuteness, and 
this loss sometimes approaches a state of deafness. These symptoms 
vary too, according to the individuals affected, and the different de- 
grees and oscillations of the disease, and even sometimes from day 
to day without appreciable cause. 

Some patients again seem to possess an extreme sensibility of 
hearing — the least noise irritates them, especially if continued so 
that they cannot put a stop to it. It seems, however, that this 
symptom must be referred to the change that has taken place in the 
character of the patients. It is not because the organ has become 
more acutely sensible that it is offended, for these patients do not 
hear better than other people, and the most harmonious sounds pro- 
duce just the same feeling of impatience when slightly prolonged. 

Another annoyance felt by such patients results from the different 
noises they have in their ears. In some there is a constant whist- 
ling ; in others, a sullen rumbling like the distant roll of the drum ; 
in others, again, the noise resembles that of a waterfall, mill, &c. 
Some patients hear many of these noises at the same time. Deaf- 
ness or difficulty of hearing accompanies these sounds. In propor- 
tion, therefore, as the normal functions of the auditory apparatus 
become weak, its pathological susceptibility augments. 

Sight. — The first change produced by involuntary seminal dis- 
charges, is a- diminished brilliancy of the eyes. These organs soon 
lose their brilliant, piercing expression, and appear dull, although 
they may not yet be either sunken or surrounded by dark circles. 
There is always more or less marked dilatation of the pupils under 
these circumstances, and this probably conduces to give the eyes 
their singular appearance. 

To the want of expression there is also joined a timidity or ap- 
pearance of shame, especially in such as practise masturbation. 
Their eyes never meet those of another with confidence; they are 
turned away hastily, and after wandering about, are at length di- 
rected to the ground. There is in this uncertainty of the organs of 
vision something analogous to the trembling of the voice, hesitation 
of speech, stuttering produced by emotion, and instability of the 
lower extremities, habitual agitation of the hands, palpitation, &c. — 
all common symptoms in these cases. Importance attaches to these 
circumstances, because we frequently meet with patients who wish 
to conceal bad habits, besides which, most of those who suffer from 
diurnal pollutions are not aware of their existence. 

In order that the eyes should become sunken and hollow, emaci- 
ation must have made considerable progress, and this emaciation may 
depend on various causes. On the other hand, the eyes may be sur- 



282 SYMPTOMS OF S PERM AT OERH (E A. 

rounded with dark circles in consequence of recent abuse or excesses, 
although the health may not be disordered: fatigue and want of sleep 
induce the same results. The conjunctiva is sometimes disposed to 
become injected from slight causes in these patients, but this is not 
a very constant symptom. Most of them present a dull and wan- 
dering eye, with a vacant expression, and these symptoms increase 
with the disease, and follow all its oscillations. Sometimes, too, the 
patients complain of involuntary contraction of the muscles of the 
eye; now and then there is spasmodic trembling of the upper lid ; 
at other times, the orbiculares and corrugatores superciliorum con- 
tract spasmodically ; at other times, again, the muscles of the eye- 
ball enter into disordered action and produce strabismus. These 
symptoms are especially observed in nervous patients who lead a 
sedentary life, and use their eyes much. 

At the same time that the previously described symptoms show 
themselves, the patient's vision becomes disordered; first at varying 
intervals; afterwards, continuously. The sight becomes progres- 
sively weaker ; small objects are defined with less clearness, and 
seem to shake, probably from want of precision in the contraction of 
the recti muscles. The patients are unable to, fix their eyes on 
minute objects without soon experiencing fatigue, headache, vertigo, 
and congestion of the head. After reading for a short time, the lines 
seem to oscillate, and the words become confused. More or less 
marked diplopia is momentarily established — probably arising from 
divergence of the visual axes caused by unequal contraction of the 
motor muscles. Other patients again, see spots, cobwebs, or flying 
points, which are constantly in motion before their eyes; then sud- 
denly, they only see a portion of the objects looked at; perhaps all 
on the left or right side, or all the upper or lower half, or some- 
times the centre or circumference; the remainder disappearing com- 
pletely for several minutes, half an hour or perhaps an hour. 

Both eyes are rarely affected in this way at the same time; when 
this happens, however, the disorder of vision is almost as serious as 
if complete blindness were momentarily established. 

These nervous disorders are frequently accompanied with cepha- 
lalgia, vertigo, noise in the ears, coldness of the extremities, vomit- 
ing, &c, and sometimes syncope occurs. The patients are naturally 
much alarmed at theseaccidents, although they do not last long, and 
the practitioners consulted seldom fail to diagnose congestion of the 
brain, and to practise abstraction of blood. This error arises from 
certain symptoms being regarded singly ; if the accompanying phe- 
nomena were taken into account, and especially the general state 
of the economy, it would become evident that all the symptoms re- 
semble one another, and that they all depend on the nervous system; 
if, therefore, the origin of the nervous disorder were not discovered, 
at least the symptoms would not be aggravated by the abstraction 
of the blood. 

Independently of these momentary and partial attacks of paralysis 



GENERAL SYMPTOMS. £83 

of the retina, this organ by degrees loses its sensibility, the pupil at 
the same time becoming dilated. Small and delicate objects are 
distinguished less clearly, and slightly continued attention brings 
fatigue. This weakening of the sight is one of the most constant 
effects of masturbation, venereal excesses and involuntary discharges ; 
it follows the loss of brightness in the eye and of firmness in the ex- 
pression ; and it is one of the most certain signs of abuse. 

The disorder of the sight, like all the other general symptoms, 
varies in different individuals and at different periods of the disease. 
In the worst cases complete blindness may be established. Of this I 
have recently seen a very remarkable example. Amaurosis brought 
on by masturbation or venereal excesses has long been recognised by 
writers on diseases of the eye, and if they have omitted to mention 
the amaurosis arising from involuntary seminal discharges, the ex- 
planation must be referred to their ignorance of the occurrence of 
such discharges. 

It has been generally admitted by writers on the eye, that amau- 
rosis caused by masturbation, or venereal excesses, is very difficult 
of cure ; the reverse obtains. Amaurosis is always a very obstinate 
disease when its cause is unknown. If the functions of the optic 
nerves are impaired by cerebral disease, by serous effusion, tumours, 
disease of the meninges, or of the bones of the head, it is evident 
that the organs cannot be readily restored to their normal condition, 
even- when an exact knowledge has been obtained of the seat and 
nature of the disease. Unfortunately numerous amauroses are due 
to causes of this nature. But when the amaurosis arises from an 
easily discoverable cause and one easily removed, the results are 
different. Thus, I have on two occasions seen almost complete 
blindness disappear by degrees, after the relief of diurnal pollu- 
tions, which kept it up. Nocturnal pollutions alone do not produce 
such marked effects, because they are far from being so serious; but 
they often cause considerable weakening of sight. In cases of this 
nature I have always seen the ocular functions restored after the 
cure of involuntary discharges ; and I have obtained similar results 
in cases which arose from masturbation and venereal excesses by 
inducing the patients to alter their habits. 

On the other hand, other patients experience very different symp- 
toms. Some are painfully affected by any bright light, whether 
natural or artificial. Some. even are unable to bear any light more 
brilliant than twilight. Notwithstanding the use of coloured glasses, 
shades, &c, they are obliged to avoid mid-day; and sometimes even 
to deprive themselves of artificial light. The retina will not even 
bear the light of a bright fire. This photophobia probably arises 
from the increased dilatation of the pupil, observable in most of 
these patients. Dilatation of the pupil is an important symptom in 
such cases, because it affords a means of diagnosis between this kind 
of photophobia, and that which arises from irritation of the retina, — 
irritation always causing extreme contraction of the pupillary opening. 



384 SYMPTOMS OF SPERM ATORRHCE A . 

To conclude, then. Among the changes observed in the organs of 
vision, those that are attributable to masturbation, venereal excesses, 
or involuntary seminal discharges, consist in a diminished activity, 
with disorder of the functions, defective harmony of action, &c. 
Sometimes weakness predominates, sometimes disorder, according 
to the temperament or idiosyncrasy of the patient; but their co- 
existence is not always easily made out. Both depend on the ner- 
vous system. 

ENCEPHALON. 

Sleep and Waking. — The opposite conditions of sleep and waking 
are marked in proportion as the health is perfect. Sleep is long 
and sound, after active and continued exercise. Hence the robust 
individual, who undergoes great fatigue, rests long and well. The 
first effect of prolonged inaction is to render the sleep lighter and 
less long. Whilst, on the other hand, broken and disturbed sleep 
disinclines the person to activity on the following day. 

This effect is very remarkable in persons debilitated by masturba- 
tion, venereal excesses, or involuntary seminal discharges. They 
sleep little and badly during the night, and habitually pass the day 
in a state of somnolence and torpor. There is good reason to sus- 
pect abuse in a child who remains motionless in a corner whilst his 
companions enjoy their noisy sports; who sighs over his lessons and 
sleeps over his books. This sign is a strong one and easily disco- 
verable; sleep during the night may be easily simulated. I have 
recently seen a child of seven years of age, who practised masturba- 
tion and passed five months without sleeping during the night with- 
out being discovered. Venereal excesses produce the same results, 
but in this case the truth is easily ascertained. 

The sleep of patients suffering from spermatorrhoea is generally 
light, broken, and unrefreshing. They get up more fatigued than 
they w T ent to bed. Hence they go to bed late and get up with un- 
willingness, even w T hen they are unable to obtain sleep in the morn- 
ing. Their sleep is unrefreshing because it is continually broken by 
nightmare and frightful dreams, which increases as the disease ad- 
vances. Painful sensations arise in the stomach, and intestines, 
liver, kidneys, or bladder, the functions of which are deranged ; pal- 
pitations and sense of suffocation are felt — the functional disorder of 
the respiratory and circulating systems coming on as during waking. 
At a still more advanced period of the disease, sleep leaves the 
patient entirely. They often pass a whole night in agitation without 
being able to find a comfortable posture; they get up and 'lie down 
again, walk about, or roll on their beds ; at one moment their bodies 
and temples are on fire, at the next they are chilly, and covered with 
cold sweat. During these long nights they constantly dwell on sad 
thoughts and are especially tempted to commit suicide. Such dis- 
turbed nights must produce the worst consequences on- the Cerebral 
functions, for sleep alone could put an end to the nervous debility 



GENERAL SYMPTOMS. 285 

and restore its activity to the brain. Hence the loss of sleep is the 
chief cause of the torpor and somnolencj observable in these patients 
during the day. 

Cephalalgia. — Patients suffering from involuntary seminal dis- 
charges generally experience heaviness in the head and sense of 
compression of the brain, as if the organ were swollen ; others, on 
the other hand, complain of a feeling of void in the head. To these 
sensations dull pains succeed, and these are seldom fixed. 

Such svmptoms are often attributed to accidental causes, the 
patients being for the most part unconscious of their true origin. Some 
patients too, suffer from fixed and almost continual pain in a certain 
spot. I have generally found that the supra-orbital region is com- 
plained of in these cases. As the disease progresses these symptoms 
become more severe, and are conjoined with vertigo, noise in the 
ears, flushing, heat of the head, disorder in the ideas, stammering, 
&c, and hence very often structural disease of the brain is suspected, 
especially if the cephalalgia comes on habitually in the same region. 
I have met with many cases in which this happened, and which had 
been treated for years by distinguished practitioners without benefit. 

Cranial Congestion. — Although patients suffering from spermator- 
rhoea are generally pale, they are exposed to attacks of cerebral con- 
gestion, generally slight and of short duration, but sometimes very 
alarming. At first these attacks are limited to flushed face, brought 
on by constipation, difficult digestion, the collection of flatus in the 
intestinal canal, &c; at other times, by the heat of a room, acute 
emotion, sudden disorder of the circulation, or momentary difficulty 
of breathing. When the health is deranged, constipation considera- 
bly increases the flow of blood to the head, and constipation is one 
of the most common symptoms of the disorder of which I am treat- 
ing. Apparently trifling causes produce serious effects in these cases, 
owing to the increased weakness and susceptibility of the organs. In 
the latter stages of the disease, the congestion may be carried so far 
that the whole head appears swollen, of a dark red colour and burn- 
ing heat. 

Such attacks of congestion are not confined to the skin ; every 
thing concurs to show that the same phenomena take place in the 
very substance of the brain. There are present at the same time, 
vertigo, dazzling of sight, noise in the ears, and a sense of internal 
pulsation with great anxiety, agitation, and uneasiness, and in some 
cases, the intellectual faculties are deranged. When the congestion 
is severe, the patients do not recognise any one; they know not 
where they are or what they do ; but they want to change their pos- 
ture, to breathe the fresh air and especially to walk, although their 
legs can scarcely support them, and if not closely watched they are 
liable to fall. In a few cases the patients become quite insensible, 
and fall into a condition exactly resembling apoplexy. 

The medical man called during one of these alarming attacks, is 
at first struck with the congestion of the face and the increased rapidity 



286 SYMPTOMS OF SPEEMATORKHfflA, . 

of the pulse. He is told of frequent giddiness experienced by the 
patients, of embarrassed speech, and momentary stuttering, of weak- 
ness of the limbs, and even of frequent falls, of constant headache, 
&c. He naturally, therefore, concludes that the case before him is 
one presenting imminent danger of apoplexy. 

During these attacks, the brain is indeed the seat of congestion, as 
well as the face, and the medical man called is not deceived on this 
point. His error consists in not recognising the cause of the conges- 
tion, in not foreseeing its short duration, in exaggerating its conse- 
quences, and especially in treating it by the most fatal means. In 
fact, these attacks of congestion are brought on by the debilitating 
discharges ; they are alarming in proportion to the patient's weak- 
ness ; they never terminate in cerebral hemorrhage; and no treat- 
ment can be worse than abstraction of blood. 

It seems astonishing that debility should produce congestions, 
which are generally looked on as the results of plethora; but on 
careful examination it will be seen that important points of diffe- 
rence exist between them. Besides this, it is by no means re- 
markable to see similar phenomena produced by opposite causes. 

It often happens in the commencement of cerebral affections, that 
a copious abstraction of blood is followed by sudden congestion of 
the head with convulsions. No one doubts that plethora frequently 
produces palpitation of the heart, sense of suffocation, &c. ; yet we 
have just seen that the same results may be caused by an opposite 
state. The same remarks apply to the dizziness, noise in the ears, 
partial and momentary paralysis of the retina, photophobia, &c. 

These attacks of congestion become more frequent in proportion 
as the weakness progresses, but they are generally of short,duration, 
because they depend rather on the irritability of the circulating sys- 
tem, than on a too great impulse given to the blood, or over-fulness 
of the vessels. There is not, therefore, the same danger of capillary 
hemorrhage as in ordinary congestion, and still less of any conside- 
rable effusion taking place. 

An attack of apoplexy may cause death in a plethoric individual 
without producing effusion, the vessels of the brain being sufficiently 
distended to hinder the functions of the organ. When hypertrophy 
of the heart is not brought on by some obstruction to the circula- 
tion situated near the commencement of the aorta, the impulse of the 
blood may be sufficiently violent to cause extravasation in the ex- 
treme vessels ; and when the latter are diseased, a less powerful im- 
pulse may cause a rupture in any point of their coats, followed by a 
considerable clot. Nothing of this kind exists in persons suffering 
from spermatorrhoea, and hence congestion does not produce any of 
these effects, although the attacks may take place frequently, and be- 
come more alarming in proportion as the disease advances. When 
the patients die, it is rather in consequence of a slow wearing out 
than from the immediate attack ; they generally expire in a kind of 
syncope, after all the congestive phenomena have passed off — not 
the least trace of them being found in the brain or its membranes. 



LOCAL SYMPTOMS. 287 

It is evident that these attacks differ greatly in their indications, 
from other congestions of the brain. Abstraction of blood may 
prove fatal, and unfortunately this is the first idea that presents itself. 
The practitioner called, for the first time, to a patient with such an 
attack, must take into consideration the general appearance of the sys- 
tem, the state of the strength, the embonpoint, and especially the con- 
dition of the circulation. The pulse is generally hurried and irregu- 
lar, but never full, distended, or resistant. Slight pressure on the 
artery arrests the pulsation altogether; indeed it can hardly be felt, 
unless the finger barely touches the skin. With such a pulse there 
can be no danger of cerebral hemorrhage, and the abstraction of 
blood would be extremely injurious if not fatal. The pulse, there- 
fore, is the chief guide in such cases. 

Alteration of Character. — In general, the moral susceptibility in- 
creases with the progress of physical weakness. But those patients 
who are naturally hasty, become the most impatient and irritable. 
They are restless, exacting, unjust; trifling circumstances sour and 
irritate them, drawing from them complaints and reproaches. — The 
least delay in complying with their demands, or a slight awkward- 
ness in waiting upon them, throws them into a fury. 

I have seen such patients sometimes roll themselves on the earth 
in furious and prolonged agitation, when unable to obtain what they 
desired. These violent scenes of nervous excitement happen espe- 
cially after abundant or frequent pollutions. As soon as convales- 
cence commences a rapid change takes place. The predominance 
of such symptoms undoubtedly arises in a considerable degree from 
the patient's natural impatience ; but they increase or diminish in 
a remarkable manner, according to their strength ; that is to say, 
according to the frequency of the involuntary discharges. When 
spermatorrhoea commences after marriage it produces an unexpected 
change in the character of the husband, which contributes even 
more than impotence to domestic unhappiness. Frequent marks of ill 
humour, bitter words, and violent discussions soon succeed indif- 
ference — contrasting strongly with the conduct before the commence- 
ment of the disease, and consequently producing a highly unfavour- 
able impression. 

Most of these patients, too, experience a profound sense of lan- 
guor, discouragement, and melancholy, giving a peculiar stamp to 
their character, with which all observers have been struck. The 
commonness of these symptoms, the importance that has always been 
attached to them, and the discussions to which they have given rise, 
require special attention; otherwise they ought not to be considered 
separately from the other functional disorders of which I have already 
treated. But they have always been considered as a special malady, 
or idiopathic affection : I mean hypochondriasis. 

Hypochondriasis. — The patients of whom I am at present speaking 
are continually beset by bitter regrets, sombre thoughts and horrible 
presentiments. They feel a void in all their affections; nothing in- 



288 SYMPTOMS OF SPERMATORRHEA. 

terests them ; every thing fatigues and annoys them ; existence weighs 
them down without any other apparent cause than a deep disgust 
for every thing which can make life pleasant. This vague and in- 
stinctive feeling, this teedium vitee, which they are not able to explain 
to themselves, follows them everywhere and constantly tempts them 
to commit suicide. Nevertheless these same persons are most occu- 
pied about their health, and dread the greatest misfortunes. I need 
not reconsider the minute care they bestow on their digestion, the 
state of their bowels, &C, and I shall only add a few words to what 
I have already said concerning their varied and continued fears. 

During the night they fancy they see thieves and murderers every 
where ; when travelling they fear being upset, falling down precipices, 
being drowned, &c. : those who are in business fancy themselves 
ruined, or on the point of being so — the clearest and most rigorous 
calculations failing to reassure them — at all events their fears soon 
return, even if once convinced. Land proprietors whose immense 
incomes are imperishable, are nevertheless haunted by the fear of 
dying of hunger. It seems at first difficult to reconcile such constant 
cares for self-preservation with disgust of life and inclination to sui- 
cide. This contradiction would in fact be inexplicable if it arose 
from reason or will. But the two contrary impulses which govern 
these patients are equally instinctive, and depend on the same dis- 
ease. They are not opposed in reality, for the derangement of all the 
functions, and the cares, wants, and constant apprehensions arising 
from it contribute greatly to the dislike of life and to the desire to 
put an end to such great physical and moral sufferings. 

It is evident that these impulses are independent of reason, because 
they reappear with equal force, whenever the patients experience a 
relapse, although they may know perfectly well that their former fears 
were ill-founded and their disgust of life arose entirely from the pre- 
sence of involuntary seminal discharges. They admit even that it is 
natural to attribute the reappearance of such ideas to the return of 
their former complaint, but at the same time they believe themselves 
threatened by other dangers and under more unfavourable circum- 
stances; and above all things they regard their disorder as incurable, 
because it has returned. In a word, past experience fails to con- 
vince them, if ever they fall a second time under the influence of the 
disease. 

I have seen such relapses last only a few days, and take place for 
the fortieth or fiftieth time, and nevertheless the same sadness, dis- 
couragement and despair, have returned on each occasion. Some- 
times two or three nocturnal pollutions occurring in a short space of 
time, suffice to work a complete change in the character of the patient. 
But on the other hand, spermatorrhoea never pursues a uniform and 
continuous course. The discharges diminish, or cease entirely for a 
short time without the patient being able to explain the cause of such 
variations. During these intermissions a rapid improvement takes 
place in all the functions — especially in the digestion; a general 



GENERAL SYMPTOMS. 289 

feeling of comfort and vigour is experienced. The patients believe 
themselves cured, or on the point of being so, and the joy they ex- 
perience is manifested with extreme vivacity, in proportion as their 
temperaments are lively. 

The next day these appearances of happiness may again give way 
to melancholy and despair without the possibility of any person's 
divining the cause of so sudden and complete a change — effects which 
are mostly produced by the occurrence of diurnal pollutions — gene- 
rally unperceived by the patients. 

As the disease makes progress the periods of remission become 
rarer and shorter; still there are always times when the patients are 
better, and times when they are much worse, following the accidental 
diminution and increase of the involuntary discharges. Hence the 
inequality of temper, the strange changes of determination, the varia- 
bility of inclinations, conduct, and affections, which make the charac- 
ters of these patients an incomprehensible enigma. 

By recollecting what I have already stated respecting the constant 
and minute attention such patients are obliged to pay to their food, 
drink, clothing, &c, to the state of their digestion, their alvine dis- 
charges, and their urine ; to all the changes of temperature, moisture, 
and electricity; by taking into consideration all the symptoms that 
are referred to the liver, the intestines, the stomach, the spleen ; the 
annoyance of flatus; the palpitations and oppression of the chest; it 
will become evident that the reunion of all these symptoms constitutes 
the most perfect description of what is called hypochondriasis. 

Memory. — Patients suffering from spermatorrhoea, like old people, 
by degrees lose their memory for facts, dates, numbers and even 
words; and this greatly increases their repugnance to conversation. 
After beginning a sentence they often forget what they wished to say, 
or are unable to find the particular expression they desire; they be- 
come nervous and begin to stutter, as if the articulation of sounds 
were difficult. This difficulty of articulation, however, really does 
exist in the advanced stages of the complaint ; the tongue then sharing 
in the disorder of the other parts of the muscular system, and the 
irregularity of its motions being increased by the want of precision 
in the ideas. 

These patients also forget their promises, arrangements, and en- 
gagements, in fact every thing which ought to be of chief interest to 
them, just like individuals in a state of demency. 

This forgetfulness, however, does not exclusively arise from loss 
of memory ; the carelessness of the patients, and their constant pre- 
occupations, are an important cause of it. The concentration of their 
thoughts on their health renders them indifferent to other things, and 
when they neglect the most important matters, it is frequently be- 
cause they do not feel interested; for the same reason, too, they do 
not understand what is said to them, and do not consider their actions. 
It seldom happens, then, that loss of memory is the only cause of 
all the irregularities these patients commit, 
19 



290 CAUSES OF SPERMATORRHEA. 

Masturbation, even before puberty, produces exactly the same 
effects as spermatorrhoea; the same forgetfulness and neglect result 
from it, and there is especially great difficulty in retaining even the 
most simple lessons, notwithstanding the power of the memory for 
words at that age. 

Intellect. — The intellectual faculties differ greatly in different indi- 
viduals, not only from difference of education, but also from primary 
development. The results of spermatorrhoea therefore vary with 
these varying conditions; generally speaking, congenital deficiencies 
chiefly appear. In all classes of society there are, naturally, powerful 
intellects like strong constitutions; such advantages, whether they 
receive all the development of which the individuals are susceptible 
or not, are maintained better under all circumstances than those 
which have been acquired by education and exercise. 

Age also must be taken into consideration. The effects of involun- 
tary seminal discharges are the more injurious in proportion as the 
patients are further removed from that period of strength and energy 
during which the constitution possesses all its natural vigour. Hence 
it arises that the most rapid and serious intellectual changes take 
place at the beginning and towards the close of life. I have seen 
children, previously very intelligent, almost suddenly fall into a state 
of idiocy, the cause of which was little suspected on account of their 
early age, the other functions not suffering proportionately. When a 
child, after having afforded evidence of strong intellect and memory, 
experiences from day to day more difficulty in retaining what he is 
taught, we may rest assured that this does not arise from indisposi- 
tion or from idleness, as is often supposed. On the other hand, the 
slow but progressive derangement of his health, his constantly in- 
creasing loss of activity and application, arise from the same cause. 
The intellectual faculties are simply the first to feel disorder, and 
show it more than the others. 

Of course I do not here refer to idle or dull children, who have 
never been able to keep pace with their companions ; I speak of 
such. as show at first the most happy qualities, after a time relax their 
endeavours more and more without evident cause, and overthrow the 
hopes of their instructors. In such cases, diminished aptness for 
learning ought to be held quite sufficient evidence to induce inquiry 
and careful watching. 

o 

At a later period venereal excesses may suddenly cut short, in a 
brilliant career, those who have escaped the dangers of masturbation. 
All such unexpected reverses are easily explained by those who are 
aware of the influence of the genital system over the intellectual 
faculties. Correct information would clearly show why some chil- 
dren cease to carry off the prizes of their class; and why at a later 
period, some young men fail in studying the law, medicine, or the 
sciences, after having successfully commenced such studies. 

Nevertheless these first failures would be only momentary if they 
were not afterwards kept up by the occurrence of involuntary dis- 
charges; most of the patients succeed in correcting themselves, 



GENERAL SYMPTOMS. 291 

/ although perhaps only when they are no longer able to continue their 
habits; after which they are almost invariably ignorant of the cause 
that prevents the return of their former intellectual energy. On the 
other hand, again, involuntary seminal discharges, do not always arise 
from masturbation or venereal excesses ; they require particular at- 
tention therefore on all accounts. 

I have already spoken of congenital weakness of the genital organs, 
and the disposition to involuntary discharges arising therefrom; I 
have mentioned, too, that intellectual excitement of all kinds, when 
carried too far, irritates and weakens such organs. Hence it is clear 
that literary men, artists, savans, &c, by giving themselves up too 
ardently to the study which interests them, are exposed to involun- 
tary discharges, however little they may be liable to them from other 
causes. Active cerebral excitement at first produces increased ac- 
tivity in the sexual organs, especially if a sitting position be long 
maintained — a slight increase of virility resulting. Long continued 
application, however, added to want of exercise, &c, weakens all 
the functions, commencing with the least energetic. The erections 
diminish and disappear, which seems natural enough when the ab- 
sorption of the thoughts is taken into consideration ; but after a short 
time mental application becomes less easy and more fatiguing, and 
its results are not so satisfactory. 

In this condition exercise and relaxation may re-establish the ce- 
rebral functions ; but after a time these means only produce slight 
improvement. All those notions of advancement, which had sus- 
tained the powers under intense study, must be abandoned, and give 
place to the constant care of health, which deteriorates daily. 

What has taken place in these cases ? Involuntary discharges are 
established, or have notably increased in frequency. These dis- 
charges keep up the weakness of the previously over-worked brain, 
and oppose the re-establishment of its functions, notwithstanding the 
most constant hygienic care. Such patients are generally in the prime 
of life, and completely absorbed by their studies, when they first feel 
their intellectual powers rapidly decline. The absence of all appa- 
. rent symptoms on the part of the genital organs, prevents the patients 
from there seeking the cause of the disorder: they only regard it as 
the effect of an over-worked nervous system, which, in a few in- 
stances, is actually the case. Under these circumstances, however, 
a short respite from study, combined with exercise, restores the pa- 
tient for a time ; but he relapses after further application, and these 
means are of no service: involuntary discharges are now established, 
and alone oppose the patient's recovery. The nocturnal pollutions 
diminish, but the symptoms increase — diurnal ones have commenced, 
and become daily more frequent, and consequently more injurious. 

Insanity. — Many patients had been treated in lunatic asylums be- 
fore they came under my care. In these cases the disorder of tbe in- 
tellectual, moral, and affective faculties varied from severe hypochon- 
driasis to violent mania. Strange hallucinations, together with in- 



292 SYMPTOMS OF SPERMATORRHEA. 

clination to suicide, temptation to commit murder, and violent fits of 
rage, were common. For these reasons the patients had been placed 
in asylums, and treated like ordinary madmen; but in all the cases 
that have come under my notice, the mental derangement followed 
the variations of the involuntary seminal discharges in all respects. 

Mania, however, is the least common of all disorders of the brain, 
produced by spermatorrhoea. The chronic form of derangement is 
much more frequent. This disorder corresponds in a remarkable 
manner with that described by Pinel as melancholia ; by Dr. Rush as 
tristimania or hypochondriasis, and by Esquirol as lypomania. In all 
cases of this disorder the distinctive characters are, — an irresistible 
sadness, melancholy and depression of spirits, fondness for silence 
and solitude, with thoughts constantly engaged in imagining dreadful 
events about to happen ; universal distrust, often carried as far as the 
most savage misanthropy; extreme timidity of character; a series of 
hallucinations, generally bearing on plots against life or imaginary 
persecutions ; and, lastly, above all, a profound disgust of life ; and, 
in consequence, an instinctive and continual impulse to suicide. 

Such are the symptoms given by all authors as characterizing this 
particular class of mental diseases : I need scarcely remark that they 
coincide exactly with those of patients suffering from spermatorrhoea. 
We must therefore admit, that spermatorrhoea remarkably favours 
the development of lypomania. I confine myself to asserting that 
the development of lypomania is favoured by spermatorrhoea, because 
it is necessary to admit that a primary disposition to cerebral dis- 
order must be present in these cases. Without this we should not 
be able to explain why in certain cases the patients escape all dis- 
order of the cerebral functions ; why, in other cases, these disorders 
present infinite varieties of degree; and why the same symptoms 
come on under other circumstances. We must, therefore, only de- 
fine spermatorrhoea to be a determining cause of lypomania. 

The influence of involuntary discharges is, however, so powerful 
and direct that reason is soon re-established as soon as they are ar- 
rested; whilst other modes of treatment are of little or no efficacy. 

Pinel and Esquirol. remarked the influence of masturbation and 
venereal excesses in causing melancholia or lypomania. Dr. Des- 
landes extends his observations*to all kinds of mental derangement; 
and, among other facts, he calls to the support of his arguments the 
statistics of asylums for the insane. Out of 256 individuals admitted 
into the asylum of Charenton, during the years 1826, '27, '28, there 
were 44 men whose insanity was attributable to masturbation or 
venereal excesses; whilst only three women owed their derangement 
to similar causes. Dr. Hoist, too, has given similar information, de- 
rived from the insane in the kingdom of Norway. Dr. Deslandes, 
however, remarks, that this cannot be regarded as an exact relative 
proportion, on account of the objections women would have to afford- 
ing such information. Esquirol thinks, too, that masturbation is 
more frequently concealed among females than among males. 



GENERAL SYMPTOMS. 293 

Although the observers, of whom I have just spoken, have men- 
tioned the influence of abuses or excesses in causing insanity, they 
have completely mistaken the cause which afterwards keeps up the 
mental disorder. In asylums venereal excesses cannot continue, and 
sure means of preventing masturbation are at hand; it even happens 
most frequently that both have ceased a long time without the least 
improvement in the symptoms being observed, because they are kept 
up by diurnal pollutions, as I have already shown. None of the 
authors referred to, have, however, mentioned these; indeed they are 
not even hinted at in any work on insanity. 

It is perhaps to the presence of such pollutions that we must attri- 
bute the relative paucity of cures in the male — for all who have made 
statistical researches on insanity, assert that in all countries, and 
under all kinds of treatment, there are fewer recoveries among men 
than among women. 

But all mental affections do not consist of disorder of the intellec- 
tual, moral, or affective faculties ; there may be also debility, and 
this may be the predominating phenomenon, or may exist alone. 
Dementia is the worst degree of this affection, just as mania is the 
most severe degree of insanity. Incurable cases of vesania-terminate 
in dementia; but it has long been known that dementia is not always 
preceded by mania or delirium, and that it may even reach the last 
degree of severity without being complicated with any disorder of 
the kind. Such cases, then, only differ from senile demency by the 
youth of the patients ; and this early debility may make rapid progress, 
constituting acute dementia. 

On comparing the descriptions which have been given of the diffe- 
rent kinds of dementia with the symptoms of patients suffering from 
spermatorrhoea, it is impossible not to be struck with their similarity. 
What is called simple demency really presents no difference from 
what is observed in the last stages of spermatorrhoea. In both cases 
there is invariably a progressive loss of the memory of facts, dates, 
words, &c, with loss of imagination, power, intellect, and deter- 
mination. 

We have just seen that many observers have admitted the influence 
of masturbation and venereal excesses in the production of mania and 
lypomania. Dr. Deslandes believes that these causes also frequently 
bring on dementia. I am strongly of his opinion, because the loss of 
their reason removes from the insane as well as from the idiot the 
strongest check the passions possess. Esquirol very judiciously 
observes, that masturbation is the greatest obstacle to the cure of the 
insane on account of the stupid, brutish condition into which the 
habit throws them. From this it is evident that diurnal pollutions 
must still more favour and hasten dementia, because they act much 
more energetically and without encountering any check. Persons 
addicted to masturbation are watched and mechanically guarded ; but 
diurnal pollutions are not even suspected, much less guarded against. 
They are, on the contrary, favoured by certain circumstances affect- 



294 SYMPTOMS OF SPERMATORRHOEA. 

ing the insane. Sexual intercourse is denied them; they are con- 
demned to inaction, or, at all events, are unable to obtain regular and 
active exercise; they frequently suffer from prolonged constipation, 
&c. These causes are sufficient to bring on involuntary discharges 
even in cases where there had been no previous bad habits, or vene- 
real excesses ; still more, then, must they increase spermatorrhoea, 
when once set up by previous irregularities. 

These reasons lead me to conclude that dementia is frequently 
caused by diurnal pollutions ; and this conclusion seems more strongly 
confirmed by the debility of the muscular system; for demency bears 
the same relation to paralysis that delirium does to epilepsy. 

General and Incomplete Paralysis of the Insane. — This generally 
accompanies and follows the same course as dementia; both are phe- 
nomena of the same nature, and both arise from weakness of the 
cerebral organs. General and incomplete paralysis, first noticed by 
Pinel, and studied with much attention by Esquirol, has since been 
the object of special research by MM. Delaye, Bayle, Calmiel, and 
Foville. The descriptions of all these authors agree remarkably with 
the symptoms observed in the last stage of spermatorrhoea. 

At first there is only observed slight embarrassment of the tongue, 
with stiffness in all the motions — a general awkwardness attended 
with more or less trembling. After a time certain letters or words 
are not distinctly articulated. There is still more stiffness than weak- 
ness in the limbs ; and a yet more remarkable symptom observed in 
these patients, until extreme weakness prevents it, is their constant 
desire for walking or motion. Dr. Foville, after noticing this, adds, 
" One of my patients, when first attacked by this complication, would 
not remain in the same place ; he walked from morning till night with 
extreme rapidity, and seemed compelled to this constant exertion 
more by a mechanical impulse than by a voluntary determination." 1 

The same author also notices another symptom of general paralysis 
of the insane, which I have described as frequently occurring in cases 
of spermatorrhoea. " In the course of this disorder I have frequently 
observed attacks of cerebral congestion followed by convulsions or 
coma; these lasted several hours, and were frequently repeated 
during several days. After such attacks the intellectual debility 
and the disorder in the motions, the progress of which is generally 
equal, become more marked. In many patients intervals of variable 
duration, during which the disease made no progress, were inter- 
rupted by these attacks." 

I have quoted these passages literally in order to show how far 
the symptoms, which I have described as belonging to spermator- 
rhoea, resemble those which have been noticed by the best observers 
of the insane. On the other hand, all authors admit that such de- 



1 See Dictionnaire de Medecine, et de Chirurgie Pratiques. Art. Alienation 

Mentale. 



GENERAL SYMPTOMS. 295 

bility of the muscular system does not exclusively belong to insanity, 
and that it occasionally precedes for some time the disorder of the 
intellectual faculties. 

Lastly, all who have paid attention to the general paralysis of the 
insane, have been struck with the great difference in the number of 
the two sexes attacked by this serious symptom. In a statistical 
return referring to 334 cases of insanity, Dr. Foville remarks that 
out of 31 cases of paralysis, 22 were men and only 9 women. Reports 
presented by various other observers give nearly similar proportions, 
notwithstanding differences of climate, manners, &c. Prof. Rech 
has stated the disproportion to be even more considerable in the lu- 
natic asylum at Montpellier. So remarkable and constant a diffe- 
rence cannot arise from any accidental cause, for the number of 
insane females surpasses that of males. It seems to me, therefore, 
that the great frequency of general paralysis in the male, should be 
attributed to the presence of diurnal pollutions. 

I have just stated that in the asylum at Charenton, 44 males owed 
their insanity to masturbation, or venereal excesses, whilst only 
three women were similarly situated ; and I have also noticed the 
greater frequency of recoveries in females than in males. It is im- 
possible not to be impressed with the harmony that exists between 
these three important facts, constantly and generally observed, and 
to which no cause has hitherto been assigned. 

Alterations in the structure of the brain are indeed sometimes 
found in cases of general paralysis of the insane, but even those who 
have laid most stress on them do not agree as to their importance. 
I have not found such alterations in patients dying from sperma- 
torrhoea who were affected by the same muscular weakness. Besides, 
these alterations do not explain why the general paralysis of the 
insane should affect males in so much greater proportion than females. 

I conclude, therefore, that among cases of incomplete paralysis 
of the insane, there are a certain number depending on diurnal pol- 
lutions, or which are aggravated by this disease, as I have already 
stated with regard to dementia. 

Dementia and general paralysis of the insane have been generally 
regarded as certain signs of the incurability of the insanity, even 
when only slight embarrassment in the pronunciation, hesitation in 
the motions, or trembling of the limbs existed. Nevertheless, simi- 
lar symptoms have always disappeared in patients suffering from 
spermatorrhoea as soon as the diurnal pollutions were arrested. This 
is a subject, therefore, which demands the earnest attention of prac- 
titioners who have opportunities of studying it. 

Gf-eneral character of the symptoms. — Notwithstanding the number 
and variety of the effects produced by spermatorrhoea, it is evident 
that all arise from changes in the functions of the different organs ; 
and by comparing these changes one with another, the same cha- 
racters of debility and disturbance are strikingly seen throughout. 



296 SYMPTOMS OP SPERMATORRHOEA. 

If disorder only appear to be present in certain cases, a little^atten- 
tion will show that it is accompanied by weakness also. 

Involuntary seminal discharges therefore act essentially by pro- 
ducing debility. We must also admit that these discharges excite a 
powerful and rapid influence over the nervous system; hence they 
have always been justly considered enervating . We are thus able 
to explain the numerous and varied symptoms resulting from sperma- 
torrhoea, as well as their resemblance to the symptoms produced by 
all other debilitating causes. 

Effects of masturbation on children and females. — In children, 
even at a very early age, masturbation produces the same effects as 
diurnal pollutions; only that the spasmodic symptoms are generally 
more marked than those of paralysis. This arises from the pre- 
dominating power of the nervous system at this early age; for the 
same tendency is evinced in all the diseases of children, and even 
in their slight indispositions. On the other hand, however, cases 
more or less marked, of paralysis, weakness of sight, &c, are not 
rare; and loss of memory, of intellect, and of the affective faculties, 
are frequently met with, and may reach complete brutishness. 

This unfortunate passion produces exactly the same effects in the 
female sex at all ages ; — the relative frequency of spasmodic pheno- 
mena arising from the greater nervous susceptibility of the female. 
On the other hand, the general and local weakness, occasional in 
the female, also resembles paralysis. I have recently seen a case of 
amaurosis, arising from masturbation, in a female thirty-six years of 
age, who confessed the vice when leaving the hospital, after having 
submitted to issues, setons, moxas, &c. 

In these numerous cases, therefore, seminal discharges can have 
no influence in producing, or keeping up the disease, although the 
symptoms are the same as those caused by spermatorrhoea. 

After having long reflected on these facts, I am convinced that 
the effects produced by seminal discharges may be brought on by 
any other debilitating cause, whose action on the economy is rapid 
and important ; and that of all such causes those which have their 
seat in the genital organs are the most enervating, and consequently 
the fittest to produce debility and functional disorder. 

Progress of the symptoms. — In examining the effects produced by 
spermatorrhoea, I have for obvious reasons generally supposed that 
the disease progresses regularly and continuously : such is not the 
case, however, the symptoms seldom present any uniform progress 
during the course of the disease; nothing, indeed, can be more 
irregular, even in the most severe cases, which might even be con- 
sidered continuous when compared with others. Among these vari- 
ations some may be considered of daily occurrence, and these are 
not well marked; others, again, happen less often, but last longer, 
and are most important. Numerous causes produce these irregu- 
larities in the progress of the disease; variations of temperature, 



GENERAL SYMPTOMS. 297 

hygrometric influences, atmospheric pressure, electrical tension, va- 
rieties of food, state of the bowels, and numerous other trifling cir- 
cumstances produce extraordinary effects on persons debilitated by 
involuntary seminal discharges: every observing practitioner will 
note these; I need, not, therefore, enter further on their considera- 
tion. 

Spontaneous 'Recovery. — Many diseases when left to themselves 
work their own cure, provided only they be not exasperated by the 
imprudence of the patients. This is not the case with spermator- 
rhoea — chiefly, perhaps, because the effects produced by the disease 
itself are favourable to the increase of the involuntary discharges. 
The natural tendency of this disease to become aggravated, as the 
result of its own effects, frequently leads to fatal termination. The 
patients under these circumstances generally expire in one of the 
attacks of syncope that follow the congestion of the brain, of which 
I have already spoken. In this way, also, such of the insane who 
have fallen into a state of dementia generally expire. Death, how- 
ever, in cases of spermatorrhoea, is much more frequently caused by 
some acute, or chronic accidental complication, which absorbs all 
the attention of the attendants on account of its being more evident 
and better known. The system is unable to resist such complica- 
tions on account of its previous debility. I have in this manner 
recently seen a student who was debilitated by severe diurnal pollu- 
tions carried off by phthisis after only two months' illness. In such 
cases unfortunately the spermatorrhoea is generally unsuspected, 



298 TREATMENT OE SPERMATORRHOEA, 



CHAPTER XIII. 



TREATMENT OF SPERMATORRHEA. 



Pollutions arising from direct causes. 

In the treatment of involuntary seminal discharges, it is of less 
consequence to seek their primary than to discover their maintaining 
cause. For instance, pollutions may have been primarily excited 
by masturbation or venereal excesses," and afterwards be kept up by 
affections of the skin, hemorrhoids, &c. In such cases it is evident 
that the practitioner must treat the existing cause. Involuntary dis- 
charges may either arise from actual debility, or relaxation of the 
spermatic organs, or from a state of irritation, or chronic inflamma- 
tion of the parts, after having been first produced by very different 
remote causes ; in treating such cases then the remote causes are 
not to be considered, while too much importance cannot be attached 
to the actual condition which keeps up the disease. It is this actual 
condition of these spermatic organs that must be altered in order to 
obtain a cure. 

This point must never be lost sight of in considering the means 
to be employed for the treatment of spermatorrhoea. The reme- 
dies are numerous, and of very opposite classes, requiring considera- 
ble experience and skill in their adaptation to the temperament or 
idiosyncrasy of each patient, as well as to the different stages of the 
disease. 

I shall arrange these remedies in different groups according to the 
indications to be fulfilled — beginning by considering those pollutions 
whose causes act most directly. 

Pollutions arising from ascarides. — The most constant symptom 
experienced in these cases is an insupportable itching at the anus. 
The parts on examination present no signs of eruption, but the mu- 
cous membrane lining the sphincter is red, injected and covered with 
thick mucus, sometimes mixed with blood. There are also nume- 
rous little red points, which, as well as the itching, arise from the 
pricking produced by the tails of the worms. Sometimes patients 
annoyed at the constant itching introduce the finger into the anus, 
detach some ascarides, and bring them away under the nail, 



POLLUTIONS ARISING FROM ASCARIDES. 299 

The sensations experienced are not the same at all times ; they are 
generally much more severe at certain parts of the day, apparently 
depending on the times of taking food; — the itching notably in- 
creasing about four or five hours after dinner. The stools are ge- 
nerally passed easily, are soft, very fetid, and covered with, a large 
quantity of thick ropy mucus, often filled with blood. 

Diarrhoea frequently occurs, constipation under these circum- 
stances being very rare. 

In these cases, therefore, the pollutions are as I have before said 
not caused by pressure on the seminal vesicles, but by their spasmo- 
dic contraction produced by the irritation of the surrounding parts. 
The pollution generally occurs while the patient is occupied in ad- 
justing his dress ; it takes place suddenly, and is ordinarily preceded 
by two or three spasmodic contractions of the rectum. 

Darting pains from the base of the penis to the extremity of the 
glans, are also frequently felt in these cases : these pains bear con- 
siderable analogy to those caused by the presence of stone in the 
bladder, the patients elongating the prepuce for relief in the same 
manner as in that disease. These pains are most likely caused by 
the ascarides pricking that portion of the rectum which covers the 
prostate. 

Ascarides always inhabit the lower portion of the large intestine, 
and may, therefore, be attacked by direct means — the most simple 
of all, without exception, being injections of water. When thrown 
up at a sufficiently low temperature, water kills these worms, or at 
least stupefies them, and when injected in considerable quantity, so 
as to be returned with some force, they are frequently passed even 
while alive. The injections may be commenced at a temperature 
of 75° Fah. and may be afterwards reduced to 60° or even 70° of 
the same scale. It is important to throw up as much water as pos- 
sible, because by this means the worms furthest from the anus may 
be reached, and those which are adherent to the walls of the in- 
testine may be detached. Ascending douches are very useful in 
these cases — their action being that of a powerful and long con- 
tinued enema syringe. 

These injections should especially be used in the evening, five or 
six hours after the last full meal, because this is the time when the 
itching at the anus caused by the worms is chiefly felt; besides 
which, cold injections administered at this period are of use to the 
patients for other reasons. They render the worms which remain 
less lively, cool the irritated intestine, diminish the erections, and 
place the patients in the most favourable condition to obtain that- 
sound sleep of which they are greatly in need. 

Cold water is, perhaps, the least active injection we can employ, 
since it has no action except that derived from its low temperature ; 
but on this account alone it is often preferable to injections that act 
chemically. The latter are always more or less styptic, acrid, or 
irritant, and cannot destroy the ascarides without acting on the 



300 TREATMENT OF SPERMATORRHEA. 

mucous membrane of the intestine, which is already irritated and fre- 
quently even inflamed: it is, therefore, prudent to begin by copious 
injections of water, which should at first even be used at a moderate 
temperature, as a very cold injection, when the intestine is unaccus- 
tomed to it, may produce a very injurious irritating effect. When 
the mucous membrane of the intestine has in some degree recovered 
its tone, salt and water injections may be used — the quantity of salt 
being gradually increased from one to three table spoonfuls to the 
quart of water. Two or three of these injections should be adminis- 
tered in rapid succession, or, better still, should be retained so as 
to carry the fluid as high up the intestine as possible ; care must, 
however, be taken that the solution does not contain too much salt, 
which would irritate the mucous membrane. 

Decoctions made from plants of the genus artemisia are very use- 
ful as injections in these cases; some of them, however, are some- 
what irritating to the mucous membrane. The class Labiata are less 
irritant, but their vermifuge power is less also. Whatever be the 
injection employed care must be taken that it be not too concentrated. 
When this is the case the intestine may become irritated, and this 
irritation may extend to the bladder, producing very annoying 
symptoms and rendering narcotic and emollient injections and baths 
necessary. 

A small quantity of the unguentum hydrargyri mitius introduced 
into the intestine, often puts an immediate stop to the annoyance 
produced by ascarides ; the itching returns, however, the worms in 
the immediate neighbourhood of the anus being alone affected by 
this remedy. The bichloride of mercury in very diluted solution 
is also an active remedy, but it requires great care and circumspec- 
tion in its use. 

All purgative enemata destroy ascarides, but at the same time irri- 
tate the mucous membrane. Oily injections are, however, unirri- 
tating, and consequently very useful. Camphorated solutions have 
been recommended; but although their action on the ascarides is 
very prompt, I think there are sufficient , reasons to contraindicate 
their employment. 

In very young children baths may be employed containing an in- 
fusion of one of the genus artemisia. I have even frequently seen 
these followed by the expulsion of lumbrici, when no other means 
had been employed. 

It seldom happens, however, that injections alone suffice for the 
entire removal of ascarides, some of which often inhabit the upper 
parts of the large intestine, and are consequently unaffected; it is 
therefore generally necessary to administer vermifuge remedies by 
the mouth. Calomel has always appeared to me to be the most effi- 
cacious of these : when the stomach is much disordered it is best to 
give from two to four grains of calomel at bed time; and this may 
be followed by a moderate dose of castor oil taken early in the morn- 
ing. 



POLLUTIONS CAUSED BY CUTANEOUS ERUPTIONS. 301 

At the same time that these remedial agents are employed, means 
must be taken to improve the general health, and especially the 
state of the digestive organs. It must be recollected that the pre- 
sence of worms is a sure sign of deficient energy in the intestinal 
tube ; and this is generally conjoined with constitutional debility, 
and is only to be remedied by fortifying the whole system. 

Pollutions excited by Cutaneous Eruptions. — Eruptions occur at 
the margin of the anus, causing insupportable itching, with abundant 
ichorous discharge, and excoriation of the skin and mucous mem- 
brane lining the sphincter ani. Sometimes the affection extends 
more deeply in the intestine, and then an increased secretion of 
mucus takes place. The irritation set up under these circumstances 
excites spasmodic contractions of the seminal vesicles, and conse- 
quently, pollutions, especially those which occur during defecation. 

Other eruptions occur on the prepuce (herpes preputials. ) These 
consist of furfuraceous patches, little pointed pimples, or phlyctenoid 
swellings resembling the effects of stinging by nettles; or again in 
more or less lively erysipelatous redness. These different eruptions 
are generally attended by swelling of the prepuce, with hardening 
or infiltration of the loose cellular tissue of the part, and increased 
secretion of the sebaceous matter, with intolerable itching. This 
sebaceous secretion often becomes acrid enough to excoriate the 
glans and internal surface of the prepuce. The patient cannot 
keep his fingers from the parts, which again grow more disordered 
in proportion to his attempts to obtain relief from the itching. Some- 
times, too, a degree of salacity is present, which has no relation 
whatever with the patient's real powers. Eruptions occurring on 
the skin of the penis, scrotum, perineum, groins, pubes and the in- 
sides of the thighs, may produce nearly the same effects. 

Sometimes urethral discharges just as profuse and painful as those 
caused by blennorrhagic virus occur in these cases ; and these may 
be followed by inflammation of the testicles or bladder, or even 
nephritis. 

The eruptions may also suddenly leave the genital organs and 
commence in some other part of the body; and when this happens 
the pollutions generally cease for the time, to return again with the 
return of the disease to its old seat. 

In the treatment of these cases it is always necessary to begin 
by using baths of either the natural or artificial sulphuretted waters. 
Care must be taken that these baths be neither too strong nor too 
hot; artificial sulphuretted baths should at; first only contain a 
small proportion of sulphuret of potassium, and their strength and 
temperature may be gradually increased. The natural waters are 
frequently of too high a temperature for these excitable subjects ; 
from 80° to 90° Fah. is generally quite sufficiently warm for the first 
trials. 

After the natural sulphuretted waters have been used as baths for 
some little time, they may be taken internally and employed as 



302 TREATMENT OP SPERMATORRHEA. 

douches on the perineum and loins, and as enemata, or as ascending 
douches, into the rectum. The direct action of douches on the 
cutaneous tissues is very important; in consequence of the percus- 
sion, the water stimulates the skin much more than when simply 
used in baths. I have often seen eruptions that had long withstood 
the remedial action of sulphuretted waters taken internally, with 
the simultaneous use of baths, cured in a few days by douching the 
affected part. 

In eruptions about the anus, we have no remedy equal to ascend- 
ing douches, especially where the disease extends to the mucous 
membrane of the gut — this structure being acted on as well as the 
skin of the anus. Injections into the bladder by means of a double 
catheter are useful in some cases of chronic discharge from the lining 
membrane of that organ ; but here great care is necessary, and the 
stream should be rather continuous than powerful. 

Sometimes the immediate eifect of sulphuretted waters is to pro- 
duce a degree of excitement that increases the involuntary dis- 
charges. The final results are, however, almost sure to be favour- 
able. 

Occasionally, again, good effects are experienced at first, but 
afterwards disappear: new attacks of urethral irritation come on 
accompanied with discharge, &c, as before, and referrible to con- 
tagion. I have known such relapses occur four or five times, not- 
withstanding the annual use of sulphuretted waters, and other treat- 
ment. 

In such cases it becomes necessary to remove the condition of the 
mucous membrane that keeps up the irritation ; and this result can 
only be permanently obtained by cauterization. 

On the other hand, again, the use of sulphuretted waters is often 
highly advantageous in cases that do not depend on cutaneous dis- 
ease — those that are due to a too great susceptibility of the genital 
organs for instance. The mildest class of waters should be chosen 
under such circumstances, and great circumspection is necessary in 
their employment. 

In all cases in which the sulphuretted waters are employed, care 
must be taken to warn the patient against the injurious modes of life 
so frequent among the society frequenting mineral springs. 

Pollutions arising from Altered or Increased Secretion from the 
Sebaceous Glands. — The sebaceous matter of the prepuce and glans 
is sometimes very abundant in quantity, and remarkably aerid, 
especially in individuals subject to cutaneous eruptions. In other 
cases, it may be retained by great length of the prepuce, or narrow- 
ness of the preputial orifice. Under such circumstances, the irri- 
tation of the glans penis may bring on very serious nocturnal and 
diurnal pollutions. 

Whenever the prepuce is too long, or its orifice too narrow, it is 
indispensable to commence the treatment by its removal. This in 
many cases suffices ; others, however, require astringent lotions, sul- 



POLLUTIONS DEPENDING ON STRICTURE. 303 

phuretted baths, lotions containing a small proportion of spirit, &c. 
Simple division of the prepuce does not suffice in these cases; indeed, 
for reasons well known to surgeons of the present day, its entire re- 
moval is generally to be preferred. Where the preputial orifice is 
very narrow, and the part itself so scanty as to be firmly applied 
over the glans, this can only be accomplished by first slitting up the 
organ and afterwards removing the flaps thus made. The opera- 
tion being a familiar one, further details are unnecessary. 

Pollutions depending on Stricture of the Urethra. — Spermatorrhoea 
may either be brought on by stricture of the urethra, or being brought 
on by some other of the various causes, may be kept up by this dis- 
ease. In both cases the most urgent indication is the same. The 
involuntary discharges cannot be removed without first removing 
the obstacle to the free discharge of urine. 

Various means have been employed for this purpose, some of 
which are specially suited to particular cases. 

In an immense majority of cases dilatation, properly applied, is all 
that is required; and again, dilatation may be employed by two dif- 
ferent methods, the comparative merits of which I must hastily 
glance at. f 

Formerly strictures were always treated by dilatation continued 
over a period of two or three months, and this alone was supposed to 
preserve the patients from the danger of a relapse. This dilatation 
was generally performed by means of gum elastic catheters retained 
in the passage. Chronic vesical catarrhs very frequently resulted — 
continuing after the removal of the instrument; and the mucous 
membrane of the urethra was generally much altered in structure, 
becoming fungoid and injected. The pressure of the extremity of 
the catheter on the walls of the bladder too, often had dangerous re- 
sults; and more than once the vesical coats have been perforated — 
becoming softened by inflammation — and effusion of urine into the 
peritoneal cavity has taken place, of course followed by speedy death. 

Abscesses in the prostate also, have frequently formed, and either 
discharged into the bladder, or rectum, or, producing hard swelling 
in the perineum, been promptly opened by the surgical attendant. 
The serious results of these abscesses are well known to all practical 
men. 

Inflammation of the testicle too is a frequent attendant on the 
slow dilatation of strictures, and even when this does not take place, 
the mucous membrane of the prostate is generally thickened and 
altered in structure, — the ejaculatory canals and vasa deferentia, 
participating in the morbid action. 

Inflammation is frequently set up in the corpus spongiosum and 
cellular tissue surrounding it; and this may either go on to suppura- 
tion, and, if not opened early, ultimately form urinary fistula, or, 
the inflammation becoming chronic, one of the hard tumours found 
in such cases may result. 

By rapidly dilating the stricture, these inconveniences are avoided. 



304 TREATMENT OF SPERMATORRHEA. 

A metallic catheter should always be employed, because it is more 
easily directed and the surgeon is better able to feel the progress he 
makes. When the stricture is situated in front of the scrotum, how- 
ever, a straight instrument may be used. Whenever the contraction 
is passed the instrument should be retained during seven or eight 
hours, after which a gum elastic catheter of the same size may be 
substituted. The stricture is thus compressed, and the gorged cel- 
lular tissue subsides, so that after three or four hours more the instru- 
ment becomes loose and may be easily replaced by one of a size 
larger. If, however, the instrument be not loose in the passage at 
the expiration of this period, it should be left a few hours longer. 
By proceeding in this manner every four hours within two days, the 
largest catheter the urethra will contain may be easily passed into the 
stricture — each new introduction of a larger instrument being easier 
and less painful than the preceding. As a rule, strictures which are 
not very narrow or resistant, are cured without relapse by this simple 
proceeding, but old, resistant, and lengthy strictures again contract. 
After a certain time, the patients perceive a diminution in the stream 
of urine, and when this takes place slowly and without evident 
cause, dilatation must again be had recourse to, commencing by the 
introduction of the largest catheter which will pass the contraction. 
Sometimes, however, the stream of urine becomes suddenly diminished 
after excesses of any kind, horse exercise, &c, and under these cir- 
cumstances, baths should be used with emollients, to remove the 
accidental irritation. Where it is necessary to have recourse a second 
time to mechanical dilatation, perfect results are generally obtained 
in half a day, or at most in twenty-four hours, the stricture not 
having been permitted to attain its former degree of contraction. The 
patient may now be instructed to pass the instrument for himself and 
recommended to have recourse to the method of rapid dilatation 
whenever the same indications present themselves. The periods of 
contraction of the stricture become more and more distant, and 
even in the most refractory cases perhaps do not recur for years. 

The plan of rapid dilatation possesses, therefore, all the advantages 
of the slow process, without its inconveniences. 

Cases of traumatic stricture, such as those caused by a fall on the 
perineum, &c, are exceptions to this rule. The long-continued pre- 
sence of a catheter is indispensable in these cases; indeed, they are 
difficult of cure by any means. 

There are some cases of stricture, however, in which, notwithstand- 
ing the numerous advantages of rapid dilatation, it must give way to 
other means. When the stricture is situated at the orifice of the 
glans, dilatation cannot be had recourse to without causing extreme 
pain, besides which the contraction readily returns. Incising the 
stricture in the direction of the frsenum, is a much simpler and more 
rapid means of cure. The union of the wound must be prevented 
by passing daily, for a week or so, the extremity of a large bougie 
just into the canal. The lips of the wound being prevented from 



POLLUTIONS DEPENDING ON STRICTUXE. 305 

uniting, cicatrize separately, and there is no danger of a return of the 
contraction. Even when the stricture is situated two or three lines 
within the orifice, incision with a straight probe-pointed bistoury may 
be had recourse to with advantage. 

There are also some annular strictures which, from their elasticity, 
return rapidly to their former degree of contraction, as soon as the 
dilating instrument is removed. These strictures should be scari- 
fied in different parts of their circumference, by a bistouri cachee 
adapted to the purpose, 1 and afterwards full sized instruments should 
be introduced daily for an hour or two. 

Some strictures bleed from very slight causes, and others again, 
are extremely sensitive. In both these cases dilatation is objection- 
able — indeed, in certain cases of irritable stricture, the patients are 
unable to submit to it on account of the agony produced, frequently 
followed by fever, rigours, &c. In these cases cauterization of the 
irritable surface with the nitrate of silver is the only means by which 
a prompt and permanent cure can be obtained. 

Lastly, there are impediments to the discharge of urine situated 
externally to the mucous membrane. These consist of little tumours 
developed in the spongy tissue of the urethra, or even still more 
superficially; these tumours can only be dispersed by external in- 
cision. A large catheter should be passed into the urethra, so as to 
cause the tumour to project beneath the skin, which should then be 
freely divided with a straight bistoury; the cellular tissue and tumour 
are in their turns to be treated in the same manner. The tumour 
afterwards suppurates and disappears completely. 

Pollutions arising from Hemorrhoids. — Hemorrhoids may cause 
involuntary seminal discharges in two ways — by the irritation they 
excite — and by acting as mechanical impediments to defecation. 

In the first case the tumours become swollen and painful, and the 
irritation extends to the prostate and neck of the bladder. Vegetable 
and milk diet should be used in these cases, with warm baths, cold 



I The instrument to be used for this purpose should not be constructed on the 
principle of a lancet shaped stilet. In pushing forward the pointed extremity of such 
an instrument it is almost impossible to be assured of the direction in which the in- 
cision is made ; besides which the elasticity of the stricture will allow it to give way 
before the point, of the instrument, however well set, when the thrusting motion alone 
is depended on to produce the required effect. In all cases too for which this opera- 
tion is suited, it is possible to dilate the stricture by means of a somewhat conical in- 
strument. It is far better, therefore, that the bistouri cachee should be sheathed in the 
substance of a solid sound, and made to project slightly by means of a screw, after the 
instrument has been passed entirely through the stricture, the incisions or notches in 
which may thus be made while withdrawing the instrument, and with a proper cut- 
ting motion. For strictures in front of the perineum, a straight instrument may be 
used, and this will have the advantage of being turned round in the urethra so as to 
notch several parts of the stricture. For strictures nearer the bladder several instru- 
ments will be required, if it be necessary to incise more than ore aspect of the stric- 
ture. In all cases the projection of the bistouri cach6e should be regulated by means 
of a screw, so that the exact depth to which the incisions will extend, may be known 
by a single glance at the handle of the instrument. [H. J. McD.] 

20 



306 TREATMENT OF SPERMATORRHEA. ; 

and opiate enemata, and emollient poultices when the tumours be- 
come prolapsed and painful. In this state too, much and immediate 
relief may be obtained by puncturing the most distended tumours with 
a lancet; the swelling goes down, the pain is relieved, and often the 
hemorrhoid withers away and becomes completely obliterated. The 
practice of applying leeches to these tumours cannot be too much 
reprobated. The leech-bites increase the irritation, and it is evident 
that the effect desired, viz., that of emptying the tumour of its con- 
tents cannot be accomplished by these creatures, their bite not being 
sufficiently deep to extend through the coats of the tumour. 

When the hemorrhoids are sufficiently large and numerous to im- 
pede defecation, they must be unhesitatingly removed — especially 
when they become hard and begin to degenerate. Care must be 
taken in operating for the removal of these tumours when internal to 
the sphincter, to cauterize the bleeding surface with the heated iron, 
after each stroke of the knife. 1 There is no occasion to form a deep 
slough — it is simply necessary to close the orifices of the bleeding 
vessels. For this purpose the small olive-shaped cauterizing irons 
are the most convenient. 

Pollutions caused by Cicatrices in the Neighbourhood of the Anus. 
— Accidental cicatrices in the neighbourhood of the anus, or within 
the rectum, may cause very serious pollutions on account of the ob- 
stacle they present to free defecation. It is evident that these pollu- 
tions can only be relieved by incising such cicatrices, and prevent- 
ing the union of the incisions by introducing an instrument capable 
of dilating the part to the full dimensions of the rectum. 

Pollutions caused by Pissure of the Anus. — I need not repeat what 



1 When hemorrhoids are situated within the sphincter ani, their removal by the 
knife is dangerous with any amount of precaution. It is far better, by directing the 
patient to strain as at stool, to cause the tumours to project beyond the sphincter, and 
then to transfix them through the base with a fixed needle carrying a double ligature. 
An unarmed needle may be passed underneath the first, and the ligatures tied on each 
side, underneath the second needle. This proceeding causes little pain when the por- 
tions strangulated consist only of mucous membrane ; should, however, a portion of 
skin be included, the suffering is generally intense — ample reason for avoiding the ap- 
plication of a ligature when the piles are external. The strangulated portions seldom 
give any further trouble, and unless the stools be carefully examined, even the liga- 
tures are generally discharged unnoticed. 

The ligatures for this purpose should consist of fine, smooth, even, and very strong 
whipcord. Silk, however often doubled, will seldom bear the force required to draw 
the ligature tight, and besides, this repeated doubling makes a thick cord which does 
not so perfectly strangulate the tumour. In external hemorrhoids when recent and 
inflamed, the practice of puncturing with a lancet cannot be too strongly recom- 
mended. The hemorrhage that takes place relieves the congestion of the hemorrhoid- 
al veins as well as the irritation of the neighbouring parts, and by gently pressing 
the tumour, if it have not already disappeared on the following day, a small clot will 
generally be discharged, after which the pile will for the most part shrink up and 
give no further trouble. When, however, external piles are of long standing, they 
should be freely removed by the knife. Smart hemorrhage sometimes follows, con- 
tinuing for a few minutes : no danger is to be apprehended from this, as it soon ceases 
spontaneously, or at all events, may be immediately arrested by light pressure with a 
compress of lint. [H. J. McD.] 






POLLUTIONS CAUSED BY CONSTIPATION. 307 

I have already said respecting the different modes by means of which 
anal fissures may Cause pollutions. The action is precisely the same 
as that of hemorrhoids. 

The indication to be fulfilled is of course to obtain a cure of the 
fissure, and this is only to be accomplished in severe cases by di- 
viding the sphincter ani. 1 This operation must be performed to- 
wards the side opposite to that on which the fissure is situated. 2 
With regard to the treatment after the operation I must remark^ 
that I consider the plan of stuffing the wound with charpie injurious 
and inconvenient; great irritation often results from it, and fre- 
quently hemorrhage is kept up, which would otherwise speedily cease. 
The wounds heal just as perfectly without this dressing, and I have 
lately given up its use in all cases where division of the sphincter 
ani is required. 3 

There are some cases of anal fissure which apparently depend on 
a syphilitic taint. These are readily cured by the introduction of a 
small suppository containing mild mercurial ointment. 4 

Pollutions produced by Constipation. — Constipation is sometimes 
the cause of spermatorrhoea; but it is much more frequently one of 
the results of the disease; at all events, costiveness is almost always 
an accompaniment of it. In all cases it is undoubtedly of importance 
to relieve the constipation, even when it is not the primary cause of 
the disease. Both surgeons and patients, however, have for the 
most part fallen into a strange error in considering that to cure the 
pollutions it is sufficient to procure free evacuation of the bowels. 

Diurnal pollutions indeed, which are simply accidental, disappear 
as soon as the momentary costiveness causing them has been relieved; 



1 The free application of the nitrate of silver in substance will relieve many cases 
of fissure of the anus, even when very severe. The application gives sharp momen- 
tary pain, but this soon passes off, and great relief is immediately afterwards expe- 
rienced. [H. J. McD.] 

2 When the fissure is not situated in the anterior portion of the anus — the direction 
of the urethra — this operation may be performed by simply dividing the parts through 
the fissure. The irritable surface is thus converted into a simple wound, which in- 
flames, suppurates, and generally heals without further trouble. 

In all cases of fissure of the anus, as well as in cases of hemorrhoids — indeed, in 
all affections of the lower bowel — too much attention cannot be paid to the state of the 
digestive organs and liver. It must be recollected that disorder of these viscera is by 
far the most frequent cause of rectal disease, and that without first removing such 
cause no local treatment can be permanently successful. [H. J. McD.] 

3 There can be no doubt as to the propriety of avoiding the filthy dressings still too 
often used, and the abominable practice of stuffing up wounds made by operation on 
the lower bowel. In all cases when any dressing is required, a narrow strip of lint, 
dipped in a little tepid water, suffices. In the after treatment of divided sphincter 
ani, an aromatic lotion — the red wash of the University College Hospital — consisting 
of about a scruple of sulphate of zinc, four drachms of spirits of rosemary, one drachm 
of compound tincture of lavender and ten ounces of water — is generally the only ap- 
plication necessary. [H. J. McD.] 

4 The origin of such fissures from a syphilitic taint, I cannot but consider very 
doubtful. Certainly the local application of the mild mercurial ointment would, ac- 
cording to the generally received notions of constitutional syphilis, be of very little 
efficacy in curing a secondary sore. [H. J. McD.] 



308 TREATMENT OF SPERM AT OREH CE A . 

but in such cases spermatorrhoea has not become a confirmed disease, 
and the health is not seriously disordered. 

On the other hand, I have met with cases in which diurnal pollu- 
tions brought on by old standing and obstinate costiveness, continued 
after the bowels had been restored to their normal action. Case 
nineteen is a striking example of this. 

The means generally employed to relieve constipation are so well 
known, that I need not consider them separately. Ascending douches 
are in my opinion by far the most efficacious and useful in all cases. 1 
Purgatives on the other hand are injurious, however administered 
and of whatever nature they may be ; laxatives such as castor oil, 
magnesia, &c, are less injurious, but these possess the notable in- 
convenience of adding to the gastric disorder. Saline purgatives, 
such as sulphate of soda and magnesia, irritate the mucous membrane 
of the alimentary canal, which is generally very easily affected in 
these cases. Aloetic purgatives have, in addition to this, the great 
objection that they act chiefly on the lower intestines, especially the 
rectum. 

I have formerly stated that active purges may excite pollutions in 
persons previously free from them, from the facility with which spas- 
modic contractions of the rectum extend to the seminal vesicles ; and 
I have shown that pollutions brought on in this way may continue 
after the action of the exciting cause has passed away, so that a 
serious case of spermatorrhoea may remain, the progress of which 
afterwards becomes independent. It is, therefore, evident enough 
that the abuse of purgatives may seriously increase previously exist- 
ing involuntary discharges, which were more the cause than the ef- 
fect of the constipation. 

On the other hand, most of these patients are in the constant habit 
of swallowing purgatives, not only because they are obstinately cos- 
tive, but also because, from the remotest records of medical science, 
it has been laid down as a rule that hypochondriacs cannot be too 
much purged — most persons affected with spermatorrhoea, as I have 
before said, being more or less hypochondriacal. The profession 
cannot, therefore, be too much on their guard against yielding to the 
solicitations of such patients — who perhaps, only complain, or com- 
plain chiefly, of constipation. 



1 The power of the douche bath in relieving constipation, has been very generally 
overlooked in this country. Ascending douches directed against the anus seem, from 
the experience I have at present had of their use, likely to be a very valuable remedy 
in cases of deficient action of the colon and rectum. The temperature of the douche 
should be from 80° to 90° Fah. and it should be continued about ten minutes. The 
direction of the spout may be varied, and the water thrown on the abdominal parietes, 
v> ith very good effects. [H. J. McD.] 



POLLUTIONS FROM RELAXATION AND DEBILITY. 309 



CHAPTER XIV. 



TREATMENT OF SPERMATORRHOEA. 

Pollutions caused by Relaxation and Debility. 

Involuntary seminal discharges arising from general atony and 
following serious acute diseases are very rare. The same indications 
are presented as in other prolonged convalescences. To the general 
means proper to restore the strength may however be added such 
special ones as act chiefly on the genital system : such are Spa water 
mixed with generous wines, most of the gum resins, canella bark, 
highly seasoned dishes, game, &c. 

Pollutions are much too frequently attributed to debility of the 
genital organs : nevertheless in certain cases such local atony may 
either originate or keep up spermatorrhoea, which then frequently 
yields to the simple administration of general or special tonics. 
Debility may continue also after other causes have ceased to operate ; 
the same indication is to be fulfilled when this is the case. 

This simple atonic condition is to be suspected when there are no 
symptoms of local irritation — especially in such as have suffered 
during infancy from incontinence of urine, in those whose genital 
organs are nofrperfectly developed, or whose temperaments are mark- 
edly lymphatic. When the scrotum is pendulous and oedematous, 
and the veins of the spermatic cords are varicose, with the glans 
penis pale at its orifice, and urethral canal little sensitive to cathe- 
terism, there can be no doubt of the presence of atony. 

The effects produced by atmospheric changes give us important 
information on this head. We may be convinced that pollutions 
arise from atony when they are increased during mild and damp 
weather, while, on the other hand, they decrease during dry winds, 
with sharp cold. These opposite effects show clearly enough that 
tonics are indicated. 

Galvanism may be employed very advantageously in torpidity of 
the genital organs; the shocks should especially be passed between 
the loins and pubes and afterwards between the loins and perineum. 
After each sitting the patients experience a feeling of strength and 
warmth in the pelvis, which constantly increases ; the bladder and 
rectum contract more energetically, and the constipation ceases. It 



310 TREATMENT OF SPERMATORRHEA. 

is evident enough that galvanism would be injurious in cases where 
there is the least irritation. 

Cantharides are constantly ordered by charlatans in cases of im- 
potence. I have never met with a single patient who did not regret 
this treatment, and suffer from it. The remedy is one which should 
never be administered to persons suffering from spermatorrhoea. 

Phosphorus, which has been recommended in these cases, falls 
under the same denunciation. 

The ergot of rye has recently been recommended in cases of sper- 
matorrhoea, and from experiments I have instituted, I am inclined 
to think that it will prove of much service in pollutions arising from 
atony. The dose should be from four to twenty grains, night and 
morning, and the best method of administration is by suspending 
the freshly powdered ergot in a glass of water. 

Cold, fresh, and salt water bathing have been so generally recom- 
mended in cases of involuntary seminal discharges, that I feel it 
necessary to insist strongly against their indiscriminate employment. 
Bad results arise from them when there is either great constitutional 
debility, or too great susceptibility of the genital organs. Of these 
different classes of patients, the one is compelled to give up bathing 
because sufficient reaction does not take place, and the other be- 
cause the involuntary discharges are considerably increased. The 
abstraction of heat can never directly augment animal strength and 
activity. The tonic effect resulting from cold bathing is, therefore, 
clue to the vigorous reaction that follows, and it is the duty of the 
medical man to consider the constitution of each individual in order 
that the bath maybe employed with the most suitable effect in each 
particular case. My experience has taught me that the ordinary 
mode of cold bathing is chiefly useful in cases of masturbation, or 
of venereal excesses ; in these cases, too, the exercise of swimming 
may be advantageously added. Cold bathing is also useful in recent 
cases of nocturnal pollutions, but care must be taken, provided de- 
bility have made even slight progress, not to permit more than sud- 
den immersion into the water; and even this must be left off when 
reaction is slow in taking place. When diurnal pollutions have 
commenced I consider cold bathing highly injurious. If it be 
necessary to stimulate the cutaneous surface in such cases, other and 
more direct means must be had recourse to. We may for instance 
employ warm aromatic baths — especially in patients who suffered 
from incontinence of urine during childhood. 

In all cases care should be taken to employ active friction on the 
skin when the patients leave the bath ; after which flannel should be 
immediately put on. 

In some cases, cold applications, or lotions to the genital organs, 
are borne when general bathing would be injurious, on account of 
the amount of heat abstracted from the large surface exposed. Ana- 
logous but more powerful effects are produced by friction with ice, 
&c, applied over the same parts; or a small quantity of pounded ice, 



POLLUTIONS FROM RELAXATION AND DEBILITY. 311 

enclosed in a bladder, may be allowed to melt on the loins, or pe- 
rineum. These means have been especially recommended before 
going to bed, for patients who suffer from nocturnal pollutions: 
their effects, however, often exceed what is required, and at best are 
very uncertain ; sometimes, too, disagreeable irritation of the urinary 
organs follows. 

Cold douches on the lumbar and sacral regions are more certain 
in their action, on account of the shock produced. I have frequently 
employed these douches with success — extending their application 
to the perineum. They have appeared still more useful when alter- 
nated with sulphuretted waters employed as hot as possible in the 
same manner. Reaction is much more rapidly established after 
these means. 

The first application of the douches should not exceed five 
minutes in duration. The skin will be found very red, and a feel- 
ing of heat and vigour in the parts will take place, even before this 
short douching is ended: a very powerful tonic result may be ex- 
pected as regards the genital organs, and for this reason the duration 
and force of the douches must only be increased after carefully watch- 
ing their effects for several days. After this, if not contraindicated, 
the number and duration of the cold douches may be increased. 

I have seen these alternated douches produce a state of priapism, 
even in persons who were perfectly impotent on the previous day. 
The medical attendant must, therefore, be cautious during their em- 
ployment that he does not over stimulate his patient. 

Cold drinks are generally useful and seldom injurious in these 
cases. They take the place of spirits, &c, from which the patients 
are generally obliged rigorously to abstain. Ice and iced drinks 
have of course the most powerful action, but are not proper in all cases. 
When the stomach is very irritable the use of ice soon causes pain 
and tenderness of the epigastrium, with heat of skin, red tongue, and 
quick pulse — indeed, all the symptoms of more or less severe gas- 
tritis. In other cases, again, the use of ice causes troublesome erec- 
tions followed by weight in the prostate and frequent discharge of 
urine, sometimes with diminution of the stream, and redness at the 
orifice of the glans penis ; sometimes, too, mucous discharge from the 
urethra is set up, and even vesical catarrh has occurred in more than 
one case in my practice. It is evident, therefore, that in order to 
use ice, or iced drinks with success, the digestive and genito-urinary 
organs must not be in an irritable state. The season of the year too 
must be considered; in summer reaction is rapid, and the heat ab- 
stracted by the use of ice is soon compensated ; in winter, on the 
contrary, there is a constant struggle on the part of the system to 
maintain the animal heat, and it is evident that the administration 
of substances calculated to abstract heat must be injurious. 

In the internal administration of ice, we may without inconvenience 
consult the taste of the patient. A spoonful may be given several 
times a day, pounded with sugar, or little portions of ice may be 



312 TREATMENT OF SPERMATORRHEA. 

sucked; the common ices of the pastry-cooks mnybe used, or better 
still, iced milk may be administered. In all cases it is proper to 
begin by small quantities at a time, and the action of the remedy 
must be carefully watched. 

Ferruginous waters have been very generally recommended in 
cases of debility of the genital organs. Such debility, however, when 
regarded as the sole cause of involuntary discharges, is very rare ; or 
at least it rarely exists alone; and hence it happens that waters 
containing iron so frequently fail, although in a few cases they pro- 
duce remarkable effects. In these cases, too, attention to the state 
of the digestive organs is necessary. 

Of the natural ferruginous waters, that of Spa is the most em- 
ployed. Of all mineral waters, however, those containing the oxide 
of iron are the most common, besides which they are easily manu- 
factured artificially, and the artificial waters are quite as good as 
the natural — indeed, in some cases they are better, because a larger 
quantity of carbonic acid may be forced into them. Some of the 
natural mineral springs are sufficiently warm to be used as baths, 
and this is a very useful mode of administration when the stomach 
of the patient is irritable. 

Spa water may be taken in cases of atony, mixed with wine at 
meals, and with milk, or sugar and water, during the rest of the 
day. It is probably the best and most agreeable mode of adminis- 
tering iron ; but the common forge water may be substituted for it 
without inconvenience, or better still, a solution of lactate of iron. 
Indeed, all ferruginous preparations may be used in atonic cases, 
care being taken at the same time to regulate the bowels, and to 
watch the general effects of the remedy. 

Tonic or astringent bitters may also be employed in cases of sper- 
matorrhoea decidedly depending on an atonic condition of the 
genital organs, and may sometimes be advantageously combined with 
preparations of iron. These remedies have one great inconvenience, 
viz., their tendency to bring on constipation. 

Numerous general and special excitants are contained in the 
materia medica. Almost all the labiate and umbelliferous plants 
possess high stimulating properties, and they have accordingly been 
strongly recommended in cases of impotence — which, it will be re- 
membered, was formerly always supposed to arise from atony of the 
ejaculatory ducts. From my experience, however, even when in- 
voluntary seminal discharges are caused by debility of the sper- 
matic organs, excitants are more frequently injurious than useful. 

The oleo-resins, such as copaiba, turpentine, &c, are more useful 
in cases of debility, accompanied with abnormal sensibility of the 
genito-urinary mucous membrane. These remedies should be com- 
menced in small doses, which- should be increased very slowly. But 
notwithstanding these precautions, the oleo-resins often disorder the 
digestive organs, and prove repugnant to many patients. Of these 
remedies copaiba is, perhaps, to be preferred. It may be given 



POLLUTIONS DEPENDING ON NERVOUS SUSCEPTIBILITY. 313 

mixed with magnesia, or in gelatine capsules, one only of which at 
first should be taken at bedtime, increasing the dose according to the 
effects observed. Tar water too may be given in doses of one or 
two tablespoonfuls mixed with water, three or four times a day. 

Nervous Susceptibility. — There are certain cases of involuntary 
seminal discharges which seem to arise from the action of the nerves 
of the genital organs, rather than from debility, or irritation. This 
disposition, however rare, merits particular mention because it pre- 
sents special indications. The genital organs sometimes possess such 
a high degree of susceptibility, that the least touch produces extraor- 
dinary sensations in them. Very slight friction suffices to cause 
incomplete erections with seminal emissions. Catheterism gives 
intolerable pain, even at the orifice of the urethra, although there is 
no redness perceptible ; painful dragging sensations are felt in the 
testicles and spermatic cords, as well as along the penis; darting 
pains with pulsation and sense of spasmodic contraction come on 
frequently without evident cause, in the perineum towards the neck 
of the bladder — probably in the seminal vesicles, because involuntary 
emissions often result without erection, or lascivious ideas, and not- 
withstanding efforts made to prevent them. These phenomena are 
especially observed in irritable individuals, who have shown from 
infancy a degree of morbid sensibility, and whose first seminal dis- 
charges were caused by unnatural excitement — especially by irrita- 
bility of temper, or lively emotions. In such patients spermatorrhoea 
becomes much aggravated in stormy weather : cold baths, applica- 
tions of ice, &c, are injurious, and tonics, internally administered, 
do not succeed better in these cases. Sedatives and narcotics may 
be employed with the best effects ; preparations of opium should be 
commenced in very small doses, however, on account of the tendency 
to headache, and the nausea they produce, as well as their increasing 
the patients' constipation. I have more than once seen such patients 
experience all the bad effects of an over dose of opium from the exhi- 
bition of an enema, consisting of a decoction made from a single 
poppy head. 

It might be supposed that camphor would be especially useful in 
these cases, on account of its particular action on the nervous system. 
I have rarely obtained good effects from it, however, and such of my 
patients of this particular class who took it in large doses, experienced 
nausea, headache, and very painful agitation ; in some even an in- 
creased seminal discharge took place. Nevertheless, camphor gene- 
rally diminishes erections arising from a state of irritation ; unfortu- 
nately its effects are very uncertain, and hitherto, no rules have been 
laid down by which to predicate its action. On one point, however, 
I am satisfied; it is, that camphor should never be given in large 
doses to these patients, as bad effects are almost invariably produced. 
I generally recommend five or six grains only at first in the course 
of the day. 

Counter-irritation on the perineum and thighs may be sometimes 



314 TREATMENT OF SPERMATORRHEA. 

advantageously employed to relieve the spasmodic contractions that 
cause diurnal pollutions; but the use of cantharides for this purpose 
must be avoided. 

The introduction of a catheter into the bladder possesses the 
advantage of putting a stop at once to the nervous phenomena of 
which the genital organs are the seat, and also of lessening the in- 
creased sensibility of the urethral mucous membrane. A moderate- 
sized gum elastic catheter should be at first employed; the introduc- 
tion should be performed slowly, stopping from time to time, both to 
allow the pain to pass off and to get rid of the spasm of the passage. 
This spasm frequently lasts more than a minute, and during this time 
all attempts at passing the instrument on must be absolutely abstained 
from. Some patients suffer such pain during the passage of the in- 
strument, that the whole body becomes agitated, and covered by 
cold sweat, and it is precisely in these cases that the catheter produces 
the most marked and lasting effects ; when the suffering is very acute, 
however, we should not persist in reaching the bladder the first time 
of using an instrument. 

At first the instrument should not be retained more than an hour, 
and in many cases it is necessary to withdraw it earlier ; at all events, 
it should always be removed as soon as its presence excites new 
spasms. It is remarkable that notwithstanding the severe pain caused 
by its introduction, the patients invariably experience a sense of com- 
fort immediately after its removal ; this is owing to the relief of the 
painful sensations which they previously felt in the genital organs — 
sensations which were by no means acute, but very disagreeable on 
account of the constant anxiety they caused. 

The effects of the first introduction must be completely allowed to 
pass off before having recourse to the instrument a second time ; a 
day or two should even be allowed to elapse after the passage of 
urine has ceased to be painful, before again using the catheter. Ge- 
nerally from five to ten days would be a proper interval, varying 
with the peculiarities of the case. And now the period of removing 
the catheter may be left to the discretion of the patient, always 
advising him to retain it as long as possible, or until very violent 
spasms commence — which happens generally in these cases in from 
one to two hours. 

The swelling which follows the introduction of the catheter ne- 
cessarily extends to the orifices of the ejaculatory ducts, and thus 
lessens the disposition to diurnal pollutions. The disordered ner- 
vous action is also modified by the presence of the instrument, and 
the sensibility of the urethra returns by degrees to its normal con- 
dition. The catheter does not simply dull, by its continued pre- 
sence, the morbid sensibility of the part; it produces at first momen- 
tary excitement, accompanied with swelling, and followed by a per- 
manent tonic effect. Hence the introduction of an instrument may 
be advantageously applied in cases of atony. 

Some patients, however, are so excitable, that they cannot bring 



POLLUTIONS DEPENDING ON NERVOUS SUSCEPTIBILITY. 315 

themselves to submit to the pain caused by passing the catheter ; 
others again, are unwilling to await the tardy results that follow 
this plan of treatment, which is necessarily lingering, on account of 
the time required to elapse between each introduction of the instru- 
ment. In these cases, therefore, other means must be had recourse to. 

Acupuncture acts with much promptitude and energy on the nerves 
of the perineum and neighbouring parts. It should be performed in 
the following manner : 

The needles should be as fine as possible, and long enough to 
penetrate nearly into the bladder; they should be tempered by heat- 
ing until they change colour, so that there may be no danger of their 
breaking, and a large head of sealing-wax should be formed for 
them, so that they may be easily managed; a little oily matter should 
be rubbed over them before using. 

After having caused the patient to make water, the first of these 
needles is to pass through the raphe of the perineum, midway be- 
tween the root of the scrotum and the margin of the anus ; the point 
must be kept in the direction of the median line, so as to traverse 
the inferior lobe of the prostate, nearly as far as the neck of the 
bladder. The second is next to be introduced between the first and 
the margin of the anus, its point being directed in the same manner; 
and the third may be inserted in front of the first, the point being 
directed obliquely towards the lower part of the neck of the blad- 
der. By this means the prostate would be traversed in the course 
taken by the ejaculatory ducts in their course to meet at the veru- 
montanum. It is difficult, therefore, for the ducts to escape being 
acted on by the needles, even supposing they should not be actually 
punctured. 

I allow the needles to remain at least one hour, and at most three; 
they may be retained longer, however, for the only inconvenience 
they occasion arises from their requiring perfect immobility. The 
extraction is generally painful. 

The patients experience, immediately after the removal of the 
needles, a sense of comfort and suppleness, which extends from the 
perineum to the neighbouring parts, and probably depends on the 
disappearance of the painful sensations previously suffered; and re- 
markable improvement in all the phenomena caused by disordered 
innervation in the genital organs usually results ; sometimes, indeed, 
such disorders do not reappear. 

The influence exercised by acupuncture over the involuntary dis- 
charges, is by no means so constant. These seldom yield com- 
pletely after the disappearance of the nervous symptoms, although 
I have seen a few cases in which the pollutions ceased after a single 
application. 

I have also several times used acupuncture of the spermatic cord, 
and even of the testicle, with advantage in cases of neuralgia in 
these parts, taking care to pass the needles between the epididy- 
mis and body of the testicle. In one case the pain ceased after 



316 TREATMENT OF SP E RM ATO RR H(E A . 

four repetitions of the operation, and I have since learnt that the 
patient married a few months after leaving the hospital. Neuralgia 
of the spermatic cords and testicles is not always accompanied with 
spermatorrhoea; but as may be supposed, the disorders are very fre- 
quently connected. In all these cases, the first indication to be ful- 
filled is the same. 

Acupuncture has unfortunately lately fallen into disrepute ; at one 
time it was sadly abused, being recommended in all classes of local 
pain, whatever its nature or cause; hence the present neglect into 
which it has fallen. Of course discrimination is required in its use; 
but in cases of spermatorrhoea arising entirely from nervous dis- 
order, (which indeed are not common,) its effects are as prompt and 
durable as beneficial. 

Pollutions arising from Habit. — To the cases I have just been 
considering as suitable for acupuncture, must be added those in 
which pollutions are kept up by habit. Not only must these cases 
be referred to the influence of the nervous svstem, but similar means 
of treatment are applicable in both. I have obtained good effects 
from catheterism and acupuncture, in patients whose genital organs 
were not very excitable, but in whom the disorder was of very long 
standing, or arose from old and long continued abuse or venereal 
excesses. 

It is very probable that the spasms of the seminal vesicles were 
kept up in these cases by the influence exercised on all organs, and 
particularly on those of generation, by the periodical repetition of 
the same acts. 

Catheterism and acupuncture should, therefore, be employed in 
these cases, when there is no more evident indication to fulfil. 

Pollutions caused by Sleeping on the Bach. — There is still another 
phenomenon which appears to me to arise from nervous influence, 
I mean the effect produced by heat of the loins during sleep. 
Amongst such as are affected with nocturnal pollutions, the greater 
number only suffer from these accidents when lying on the back. 
These cases are not generally very serious, and they may be relieved 
by the following simple means : 

The bed should be very hard, and a piece of leather or oiled silk 
should be placed between the blanket and sheet. If this do not 
succeed, it will be proper to apply a sheet of lead over the loins, and, 
better still, to adapt to the centre of this sheet a perpendicular piece 
of light wood, so that the body never can remain on the back how- 
ever sound the sleep may be. The sheet of lead may be fixed to a 
linen girdle and tied in front; and it is evident, that for the patient 
to lie on his back, he must rest equally balanced on the edge of the 
wood fixed to the centre of the leaden plate. The use of lead pre- 
vents the loins from being overheated by the presence of the appa- 
ratus, which might happen if some metallic substance were not used. 

I have always found this simple apparatus successful in nocturnal 
pollutions caused by heat of the loins during sleep. 



POLLUTIONS CAUSED BY IRRITATION. 317 



CHAPTER XV. 

TREATMENT OF SPERMATORRHEA. 

Pollutions caused by Irritation or Chronic Inflammation. 

In by far the greater number of cases, the involuntary seminal 
discharges are kept up by a state of irritation of the spermatic organs ; 
and this irritation may present various degrees of severity, varying 
from simple excitement to well marked inflammatory action. Noc- 
turnal pollutions brought on by simple excitement of the genital 
organs, are not in general either lasting or serious ; these discharges, 
therefore, as I have before stated, only merit attention on account of 
their tendency to become habitual. 

Irritation of the genital organs generally shows itself by more or 
less vivid redness at the extremity of the glans penis, by abundant 
secretion and frequent discharge of urine, by acute sensibility in the 
prostatic portion of the urethra, and by a sense of weight and dis- 
comfort in the perineum and rectum. 

In chronic inflammation the prostate is, besides, sensible to pressure 
and perhaps swollen, which may be easily ascertained by an exami- 
nation per rectum. The patients suffer from mucous urethral dis- 
charge, generally the sequel of old blennorrhagia, and which becomes 
aggravated from very trifling causes. The testicles are often mor- 
bidly sensitive, painful, and perhaps swollen. 

Spring is unfavourable to all patients whose involuntary discharges 
arise from hypersthenia; dry and cold weather is equally injurious; 
in general they feel better in warm damp seasons. Cold lotions, 
cold bathing, tonics, and excitants, are all equally hurtful. Momen- 
tary benefit may, however, occasionally arise from these means, and 
this happens because debility generally accompanies the irritation 
or chronic inflammation ; but such momentary benefit is rapidly fol- 
lowed by marked increase of the bad symptoms. It is often diffi- 
cult to distinguish chronic inflammation from irritation, and the in- 
dications to be fulfilled are the same in both states, therefore I shall 
consider their treatment together. 

Hippocrates recommended that at first the whole surface of the 
body should be fomented, that lavements should be given, and after 
a time tepid baths used. The moderns, on the other hand, have with 
one accord recommended cold bathing in all cases of spermatorrhoea, 
and this has arisen from their constantly and falsely attributing the 



318 TREATMENT OF SPERMATORRHOEA. 

disorder to atony of the genital organs. The temperature of the bath 
should be that most pleasant to the feelings of the patient : too high a 
temperature causes agitation ; too low, on the other hand, increases 
instead of relieving, local irritation. Emollient baths, containing 
vegetable decoctions, are indicated when the skin is dry, irritable, or 
covered with eruptions ; but with the exception of these cases, they are 
not more useful than baths of plain water. The advice of Hippo- 
crates relative to the diet and general regimen of such patients, 
harmonizes with the employment of these emollient means. After 
having prepared the stomach by a mild emetic, he recommends skim 
milk as a beverage, ass's milk, and during forty days cow's milk. 
"So long as this milk diet shall continue," he adds, "administer 
barley water in the evening, and forbid all solid food ; afterwards 
give soft food in small quantities at first, and* fatten the patient as 
much as possible." This fluid regimen is certainly the fittest to as- 
sist the baths, fomentations, &c, in calming the irritation of the geni- 
tal organs, by favouring abundant secretion of unstimulating urine. 
It has also the advantage of furnishing the digestive organs with 
nutriment suited to their weakening powers. 

The stomach must not be over fatigued with the use of milk, how- 
ever, and in order to prevent this, different means may be employed. 
At first new milk may be given, as soon as possible after it has been 
drawn, and this may be varied by changing from goat's milk, to 
ass's milk, and from the milk of cows to that of sheep. Afterwards 
the milk may be boiled, or given cold, or iced; sugar may be added 
to it, or jam, water and sugar. If acid eructations follow its use, a 
few grains of magnesia may be mixed with it, or two or three spoon- 
fuls of Spa-water, or, better still, of lime water. A few drops of 
rum may be added to it to give flavour, or a laurel leaf, or a sprig of 
fennel may be allowed to infuse in it while it cools. Tea and coffee 
must not be given with the milk, on account of their injurious action 
on the nervous system, but chocolate may be used in small quantities. 
The stomach is generally so capricious in these cases, that a milk 
diet could not be long submitted to unless it were constantly modi- 
fied. As, therefore, it is the most suitable diet in severe cases, care 
must be taken to vary it frequently k 

The soft food, recommended by Hippocrates to follow milk diet, 
should consist of decoctions made from barley, beans, &c, or of the 
dried juices of feculent vegetables. Of all feculent roots the potato 
is the best suited to follow the use of strict milk diet in these cases. 
The most simple mode of its preparation is the best. The potato 
is easily digested, and besides, it modifies the secretion of urine. 
Strawberries possess a similar property, and very soon relieve irrita- 
tion of the bladder and urethra. There are some patients whose 
urine is quite transparent, but who nevertheless cannot retain it long ; 
they suffer from pain and heat in the neck of the bladder and pros- 
tate, together with darting pains in the same region, but without any 
symptoms indicative of inflammation. This particular kind of irrita- 



CAUTERIZATION. 319 

tion is difficult to relieve by pharmaceutical means, but it often yields 
readily enough to the abundant use of strawberries ; raspberries and 
cherries produce somewhat similar, but much less active effects. 

The advice given by Hippocrates, " to fatten the patient as much 
as possible," is by no means opposed to the diet I have recom- 
mended, for it is well known, that matters containing sugar and 
fecula in abundance, favour the formation of fat. 

Hippocrates adds, that wine should be abstained from during a 
year, and I have frequently had opportunities of remarking the 
wisdom of this advice. Many patients, indeed, grow abstemious as 
the result of their own experience. The prohibition of wine should 
include all other fermented liquors, as well as tea and coffee — indeed, 
all exciting drinks. But there are cases of spermatorrhoea, arising 
from irritation, in which wine may be allowed, and in these cases it 
may be advantageously taken iced, or mixed with an alkaline, or 
carbonated water. 

In cases of well established spermatorrhoea, all excitement of the 
genital organs increases the pollutions ; the patients must, there- 
fore, not only abstain from coitus, but from every thing which may 
excite venereal desires, or lascivious ideas. Still, however, when 
convalescence is advancing, very moderate sexual intercourse is ne- 
cessary to relieve the overfilled seminal vesicles, and to prevent 
them from again falling into a habit of involuntary contraction. 

Fatigue is hurtful to patients whose pollutions arise from irritation, 
but moderate exercise is beneficial. Excessive mental exertion is 
also to be avoided. In the milder cases of involuntary discharge, 
caused by irritation, the introduction of a catheter may be sufficient, 
as in cases of morbid sensibility, to modify the condition of the mu- 
cous membrane. 1 The remedy in the severer cases I have still to 
consider, I mean cauterization of the mucous membrane of the 
prostatic portion of the urethra, by means of the nitrate of silver. 
Cauterization. — This operation is especially indicated in cases of 
chronic inflammation, or irritation of the urethra: its results may be 
considered certain when involuntary discharges follow a common 
clap, or non-contagious gleet. I have also found it successful in 
many cases where atony, or relaxation seemed to predominate, and 
in a few cases of marked nervous disorder, and congenital predis- 
position. In the latter cases, however, the benefit derived from cau- 
terization has seldom proved permanent, though I believe that by 
changing the condition of the tissues, the foundation has been laid 
for the successful use of other means. 

Before proceeding to cauterization it is indispensably necessary to 
introduce a catheter, for the double purpose of taking the exact length 
of the urethra, and of completely emptying the bladder. On slowly 
withdrawing the instrument, during the escape of urine, the stream is 



! I have successfully treated a mild case in this manner. [H. J. M'D.] 



320 TREATMENT OF SPERMATORRHOEA. 

arrested as soon as the eyes of the catheter enter the canal, and re- 
commences when they are again pushed into the bladder. The penis 
being then moderately stretched, the thumb and fore finger should be 
applied to the instrument at the point of the glans. When the cathe- 
ter is withdrawn, the distance between the finger and thumb and its 
eyes, gives the exact length of the urethra, and this must be imme- 
diately marked on the porte-caustique, the eyes of the catheter being 
applied to its olivary extremity, and the position of the fingers indi- 
cated by fixing a little slider on the stem of the instrument. When 
the porle-caustique has penetrated so far into the urethra, that this 
slider touches the point of the glans — the penis being exactly in the 
same state of elongation in which it was when the catheter was in- 
troduced — it is clear that its olivary extremity will be in precisely 
the spot previously occupied by the eyes of the catheter, when the 
length of the canal was taken ; that is to say, at the commencement 
of the neck of the bladder — a position which it is highly important 
to the operator to be assured of. 

The bladder must be completely emptied, in order that no urine 
may penetrate into the tube of the porte-eaustique, and that none 
may enter the urethra during cauterization. When the caustic is 
wetted by the urine, it acts much less energetically than if it were 
dry, and its action extends to parts where it was not required. The 
inflammation set up may, under these circumstances, be insufficient 
to fulfil the desired object, although, at the same time, extremely 
painful on account of its extent. 

I need not describe the instrument I use for the purpose of cauteri- 
zing the urethra, as it is pretty well known to the profession. I 
must, however, point out a few of the faults of those sold, by even 
the best instrument makers, as my instrument. The enlargement 
terminating the cuvette, is generally too round and too small. It 
closes the end of the tube like a stopper, and hence it often happens 
that the mucous membrane forcibly embracing the cuvette during 
cauterization, becomes pinched on closing the instrument, and per- 
haps portions of the membrane may be torn away on withdrawing it. 
By giving the extremity of the instrument greater volume, and an 
elongated olivary form, this accident is rendered quite impossible. 

The diameter of this olivary body should considerably exceed that 
of the tube of the instrument, because, although the operator may 
judge when he is near the neck of the bladder, by the nearness of 
the slider on the stem of the instrument to the point of the glans ; 
still, it is proper that he should have a distinct sensation when the 
neck of the bladder is reached. The passage of the enlarged ex- 
tremity of the instrument through the sphincter of the bladder gives 
this sensation very distinctly; then on gently withdrawing the instru- 
ment, a slight resistance is felt to the re-entrance of the bulb into 
the urethra, and the operator may be certain that the cuvette con- 
taining the caustic is in its proper position. 

The cuvette and the stem which supports it, should be formed of a 



CAUTERIZATION. 321 

single piece of metal, because any soldering is soon destroyed by the 
caustic. It is not, however, indispensable that the cuvette should be 
made of platinum. I have used the same silver instrument for several 
years, without its being worn by the action of the caustic. 

Very often the cavity in the cuvette intended to hold the caustic is 
carefully polished ; when this is done, the caustic does not adhere 
firmly to its sides, and there is danger of its escaping. The inner 
surface of this cavity should, on the contrary, be as rough as possible. 

The nitrate of silver must be melted into the cuvette by means of 
a spirit lamp, so that it may present, when cold, a smooth and even 
surface. So long as it continues rough, so as to project beyond the 
level of the sides of the cuvette, the projecting portions are apt to be 
broken off in closing the instrument, and to fall out when it is again 
opened. 

The patient should lie down during cauterization ; either standing 
or sitting he is less fixed, and is more apt to move his pelvis suddenly 
— an inconvenience which it is important to avoid ; the operator, too, 
is less at his ease, and less certain as to his proceedings. 

As the olivary extremity of the instrument approaches the neck of 
the bladder, the irritability of the passage increases, and the patient's 
agitation often becomes so great as to inconvenience the operator. 
The instrument should now be allowed to pass on by its own gravity, 
attention being paid to detect the moment when the olivary body 
passes the neck of the bladder: as soon as this happens, the instru- 
ment should be gently withdrawn — so as to bring its olivary extremity 
slightly within the neck of the bladder — and firmly held in that situa- 
tion, while the outer tube is a little drawn back, and the cuvette very 
rapidly -passed over the inferior surface of the prostate, by slightly 
turning the stem attached to it ; the instrument should^ then be in- 
stantly closed and slowly withdrawn from the urethra. 

In this manner the nitrate of silver reaches the prostate quite dry 
in the situation where the ejaculatory ducts open. Their orifices 
must, therefore, be cauterized sufficiently to produce a considerable 
modification in the state of the tissues. No other parts are touched ; 
and hence, the inflammation set up is at once both acute and cir- 
cumscribed. 

It must be remembered that cauterization is practised in these 
cases, in order to bring on a lasting change in the condition of the 
tissues, by means of active inflammation, and not for the purpose of 
causing loss of substance ; and hence it is not necessary to produce 
a slough. The action of the nitrate of silver should be just as rapid 
as in cauterizing the conjunctiva in chronic inflammation, ulceration 
of the cornea, &c. There is the same intention in both these diffe- 
rent cases, and the result obtained is of the same nature. 

It is now twenty years since I first commenced the practice of cau- 
terizing the prostate in cases of ancient gleet, which had resisted all 
other kinds of treatment; very soon afterwards, I applied the same 
powerful means to the treatment of involuntary seminal discharges. 
21 



322 TREATMENT OF SPERMATORRHEA. 

Since that time, I have performed the operation almost daily, and I 
have never seen, in my own practice, any of the violent effects, such 
as retention of urine, hemorrhage, long-continued violent pain, nar- 
rowing of the passage, &c, described by some operators as super- 
vening. Indeed, I should almost doubt the accuracy of these de- 
scriptions, had I not been consulted in one or two cases in which the 
symptoms had been set up. Such ill effects result from the injurious 
and absurd practice of some surgeons, of cauterizing the urethra 
during a fixed period of time, watch in hand. The time required to 
glance at the second hand is more than sufficient for applying the 
caustic. 

During the first days subsequent to cauterization, baths, enemata, 
and diluents should be prescribed, with milk and vegetable diet, so 
as to dilute the urine as much as possible. All fatigue should be 
abstained from, and exposure to cold rigorously avoided. For two 
or three days micturition is frequent, painful, and accompanied with 
the escape of a few drops of blood. But these symptoms soon pass 
off, provided no imprudence be committed. I have, however, known 
the pain continue ten days or more, in patients who committed errors 
of diet, or fatigued themselves too early, or who exposed themselves 
to cold or damp. 

These imprudences are not only injurious by hindering the rapid 
termination of the inflammatory process; they may also compromise 
its results, which depend principally on the facility with which reso- 
lution takes place. So long as the inflammatory stage continues, the 
involuntary discharges are increased rather than diminished in fre- 
quency, and sensible improvement only appears when resolution 
takes place. It is seldom that we can judge of the amount of benefit 
derived until the twelfth or fifteenth day, or sometimes longer, espe- 
cially if a return of the inflammation should take place, when perhaps 
the patient thinks himself freed from all restraint. He must be espe- 
cially warned against indulging his sexual desires, although energetic 
erections are sure to occur. Some unreflecting practitioners have 
had recourse to a second cauterization, immediately that the severe 
inflammatory symptoms of the first are dissipated, and sometimes 
have performed the operation five or six times following, expecting 
that the involuntary discharges would be arrested by such means. 
Indeed, I have seen several patients who had been cauterized every 
eight days, or even oftener, for a month or two, without other results 
than obstinate irritation and stabbing pain in the neck of the blad- 
der, with contraction of the urethra. 

It must be remembered, that it is wholly for the consecutive re- 
sults that cauterization is performed, and that these results depend 
on a change which takes place in the condition of the tissues. The 
curative action can, therefore, only show itself after the complete 
resolution of the acute inflammation set up by the nitrate of silver. 
This seldom takes place until the eighth day, and as many more 
davs are necessary before the required change is effected. I have 






CAUTEKIZATION. 323 

seen patients in whom a month and more has been required, because 
the inflammation was prolonged by accidental causes. In such pa- 
tients improvement commenced late, its progress was slow, and the 
cure was not perfect until six weeks or two months after the opera- 
tion. 

In no case can we expect to find the curative effects of cauteriza- 
tion manifested earlier than a fortnight at soonest, and a month must 
be allowed to elapse before judging of them definitely. It is, there- 
fore, absurd to attempt to set up, a second time, the inflammatory 
process, before the first has had opportunity to produce its effects. 
When cauterization is about to effect a cure, it soon becomes evident 
by the rapid diminution of the involuntary discharges, and the steady 
progress of the convalescence. It is sufficient afterwards to remove 
the circumstances that might occasion a relapse, and all the functions 
will soon be re-established. Exercise should be increased with the 
return of strength, in order to confirm the recovery. 

One operation suffices in such a case ; indeed, the operation should 
not be repeated, even although the patient, in hope of accelerating 
his recovery, may be anxious for it. Hygienic care, travelling, and 
sulphuretted waters will do the rest. A second cauterization should 
only be practised when accidental causes have prevented the first 
from producing its effects, and when a second application of the 
caustic fails to complete the cure, it is probable that a third will have 
no better success ; other means, therefore, should be had recourse to. 

When cauterization only gives momentary relief too, it should 
not be repeated, for a second and third would have no better 
chances of success than the first. Further investigation into the 
causes that keep up the pollutions, must be undertaken. Very 
often, causes previously unsuspected are discovered, the proper 
treatment for which, of course, must be employed. 

In conclusion, I may simply record my opinion, that two thirds of 
the cases of spermatorrhoea would be beyond the reach of medical 
assistance, were it not for the beneficial effects produced by the ap- 
plication of nitrate of silver to the prostatic portion of the urethra. 

Action of the Nitrate of Silver. — There is scarcely a tyro in surgery 
who has not seen the nitrate of silver in substance, applied to fun- 
gous, irritable, and bleeding ulcers; and all well know, that the 
pain caused by the application soon ceases; that the granulations 
assume a more healthy aspect, and that the discharge becomes more 
creamy, and the sore shows a disposition to heal. It is not by de- 
stroying the fungous and bleeding surface that this improvement is 
effected, but by giving tone to the vessels of the part. In affections 
of the skin, the nitrate also renders much service; but it is in chronic 
ophthalmia perhaps, that the rapidity of its effects is especially seen. 
Before cauterization, the conjunctival mucous membrane is injected, 
painful, thickened, fungoid, sometimes rough and granular. The 
follicles of the lids furnish an abundant secretion of matter, and the 
secretion of the lachrymal glands is much increased, and their pro- 



324 TREATMENT OE SPERMATORRHEA 






ducts modified, so that the discharge of tears over the cheek fre- 
quently causes ulceration. 

Immediately after the application of the nitrate of silver these 
symptoms are exasperated; the tears especially, flow in much greater 
abundance. But soon the pain lessens, and the lachrymal discharge 
becomes arrested ; on the following day the injection of the eyes be- 
comes less evident, and for several days resolution continues its 
progress, leaving the conjunctiva much paler than it was before. 

The same results take place in ulcerations of the cornea. 

In these cases, the nitrate of silver is merely drawn lightly and 
rapidly over the diseased surface, its action not being sufficiently 
continued to produce a slough. 

Precisely the same phenomena occur in the prostatic portion of 
the urethra, the action of the nitrate of silver being of limited dura- 
tion. 

In leucorrhoea too, which frequently depends on ulceration of the 
neck of the uterus, cauterization with the nitrate of silver possesses 
undoubted advantages over all other modes of treatment. The neck 
of the uterus is red, fungoid, swollen, and more acutely sensitive 
than natural; there are often excoriations varying in extent, the sur- 
faces of which, when wiped with lint, generally bleed. 

In leucorrhoea which owes its origin to a chronic inflammation, 
sui generis, of the lining of the vagina, attended by insupportable 
pruritus, and accompanied with abundant thick, acrid, yellow dis- 
charge, the nitrate of silver is often of much service. The mucous 
membrane is not only red and injected, but frequently also, rough 
and granular, and while general means are at the same time employed, 
the application of the caustic affords a very speedy mode of relief 
from many of the more distressing symptoms. 

In cases of leucorrhoea too, which depend on lymphatic scrofulous 
habit — in atonic cases in fact — the nitrate of silver will often arrest 
the discharge, and thus remove a very serious cause of debility, while 
other means are taken for the permanent improvement of the system 
generally. 

Chronic Vesical Catarrh. — During more than fifteen years I have 
employed cauterization with much success in cases of chronic inflam- 
mation of the bladder. At first, like many other practitioners, I 
dreaded the effects of such an agent on the mucous membrane, con- 
stantly bathed by the urine, and I was frequently prevented from 
having recourse to it by the terrible obstinacy of the disease. Since 
that time, however, I have found cauterization cure nine-tenths of the 
vesical catarrhs that have come under my care, many of which, too, 
had resisted various scientific treatment for years. The cases which 
cauterization failed in curing completely were much improved by it. 
Cauterization should, however, only be used in uncomplicated cases : 
where there is suspicion of suppuration in the kidneys, or of abscess 
in the prostate, opening into the bladder, this treatment is contra- 



CAUTERIZATION. . 825 

indicated. Generally a single cauterization suffices, but I have oc- 
casionally been obliged to repeat the operation three or four times. 

The bladder should be emptied as completely as possible, and the 
same instrument should be used as in cauterizing the prostate, except 
that it should be furnished with a convex cuvette. It is sufficient to 
pass the caustic rapidly to the right and to the left once only, to ob- 
tain the desired result ; it is better to be obliged to repeat the opera- 
tion than to excite too much inflammation. 

After the operation, frequent baths must be used, with emollient 
enemata, abundant diluents and rest. The inflammation passes off 
very rapidly, and I have not met with one case in thirty in which 
abstraction of blood has been necessary. 

When cauterization does not succeed in perfecting the cure, it in- 
variably so alters the condition of the mucous membrane that the 
means previously employed unsuccessfully may be used with every 
prospect of success — I refer to the natural and artificial sulphuretted 
waters, tar water, and the turpentines — especially copaiba. 

Deviation of the Orifices of the Ejaculatory Canals. — I have stated 
that cauterization should be very rapid, and confined to the surface of 
the prostate, in spermatorrhoea arising from irritation. There are, 
however, cases in which involuntary discharges are complicated with 
deviation of the orifices of the ejaculatory canals, and this deviation 
requires a slight alteration in the mode of operating. It is no longer 
necessary simply to modify the condition of the mucous membrane; 
it is required to bring forward the verumontanum, which is turned 
backwards. For this purpose it is necessary to produce a very small 
slough in front of the orifices. Instead of the ordinary cuvette of the 
porte-caustique, therefore, the instrument should be solid; but about 
fourteen lines from its olivary extremity, there should be a little ex- 
cavation about large enough to hold a grain of linseed. This is to be 
filled with the nitrate of silver in the same manner as before ; and 
when the olivary extremity of the instrument is situated at the neck 
of the bladder, the tube is to be drawn back, and the caustic al- 
lowed to dissolve entirely, in front of the verumontanum. A little 
slough results, and the cicatrix that succeeds it is generally sufficient 
to draw forwards the orifices of the ejaculatory ducts. 



326 TREATMENT OF SPERMATORRHEA. 



CHAPTER XVI. 



TREATMENT OF SPERMATORRHEA. 



Convalescence, 

In recent and simple cases of involuntary seminal discharges, 
re-establishment takes place promptly and rapidly ; all the organs 
successively resume their normal functions, without requiring any 
further treatment on the part of the surgeon. But after severe 
cases the progress from disease to health is never so simple or 
rapid. The constitution having been seriously weakened, requires 
much time and attention for its repair. Besides this, habit, which 
possesses considerable influence over ail organs, tends unceasingly 
to cause a relapse in cases of spermatorrhoea that have been of long 
duration. It is, therefore, slowly and with prudence that the patient 
should return to his ordinary diet and mode of life ; and there are 
certain hygienic precautions which in some cases must be continued 
long after the perfect re-establishment of health. 

In proportion as the energy of the digestive organs returns, 
more nourishing food is required, and the patients can no longer 
bear the strict diet which was highly beneficial at first. The pa- 
tients are also impelled by the desire of increasing their strength; 
but for this purpose it is better to permit an increased quantity of 
light food, with greater frequency of meals, than to allow, too early, 
a return to heavy diet that may disorder the digestive organs and 
thus endanger a relapse. From vegetable diet, the patient should 
proceed to fish and white meats, before having recourse to more 
stimulating food. 

Of course exception must be made here, of those patients who 
are troubled with ascarides, and in whom tonic and stimulating diet 
is required on account of their pollutions arising from atony. 

During convalescence from spermatorrhoea, arising from irritation, 
a warm and damp climate agrees best, but on the other hand, when 



CONVALESCENCE. 827 

the disorder arises from atony or from lymphatic constitution, a dry 
and pure air is required. 

When the strength is so far re-established that the effects of 
cold are no longer to be dreaded, cold bathing is very useful pro- 
vided the season be favourable : when reaction takes place vigo- 
rously, the loss of the economy caused by it diminishes the secretion 
of semen. At first the bath should consist of one plunge only, and 
if the atmospheric temperature be low, two or three days should be 
permitted to elapse between the baths. The length of time the pa- 
tient continues in the water, should be very gradually and carefully 
increased. 

Exercise should be taken in proportion to the return of strength, 
not only to increase the strength, but also in order that the products 
of digestion may be as much as possible employed in the repair of 
waste. This is the best means to prevent such materials from 
proving an undue stimulus to the spermatic organs. Travelling is 
highly useful after spermatorrhoea has been cured; but in order that 
the best results should be derived from it, the patient should travel 
on foot. Carriage exercise favours constipation, and excites the geni- 
tal organs, and horse exercise possesses both these inconveniences 
in a still higher degree. 

I have more than once stated that the seminal secretion is 
never completely arrested in man except after long and severe ill- 
nesses. The pollutions will therefore return, provided absolute con- 
tinence be persevered in. Such pollutions may occur so rarely as 
not to exert any injurious influence on the health; but they may 
increase by simple habit, or by the action of irresistible accidental 
circumstances. In order that involuntary seminal discharges, there- 
fore, should cease entirely, it becomes necessary that they should be 
replaced by normal voluntary emissions. The regular exercise of 
the organs, too, can alone restore to them their proper energy. This 
is the case with all the organs of the body, and the generative are 
by no means an exception to the general rule. In order, therefore, 
that the return to health may be durable, regular sexual intercourse 
must be established. The question now arises; when ought such 
intercourse to be permitted ? The answer is : when continued 
continence has become so painful as to bring on actual fatigue of 
the generative organs, and when no further progress is observed in 
the development of their energy. There is then danger that the 
organs may lose power and fall into a state of debility from too long 
inaction. 

The surgeon is now consulted by the patient and his friends as 
to the propriety of his marrying; and this is one of the most 
difficult questions to decide. Marriage ought not to be contracted 
until the fullest proofs of a perfect and permanent return to health 
has been given. The responsibility of sacrificing the happiness 
of the female is to be considered seriously, as well as the possibility 



828 TREATMENT OF SPERMATORRHEA 






of a relapse occurring to the patient, from comparatively unre- 
strained indulgence during the first months of marriage. On this 
subject, however, I think that no decided rules can be laid down ; 
the matter must be left to the judgment of the surgeon, after he 
has carefully considered all the circumstances affecting each par- 
ticular case. 



THE EXD. 



" ( 



0CT1958 



